Parenting Essentials Plus Registration

Parenting Essentials Plus Registration

This is the full Parenting Essentials Plus Workbook registration form. Once this form is completed you will be sent an invoice for the number of workbooks you have ordered, as well as instructions about next steps!

Parenting Essentials Plus is a series of 8 parenting support videos that provides useful parenting and caregiver tips and tools that can be put into practice immediately. This series braids seven positive parenting core competencies with strengthening families’ protective factors and fulfills the top 3 outcomes for Head Start parent and community engagement framework. With Parenting Essentials +, parents get the opportunity to watch one parenting video per week or per month and go over the corresponding lesson in their workbook. They then attend an in-person meeting to review the content, go over the workbook exercises, and talk through their experiences with facilitators and other parents.
Contact Information:

(Information about yourself.)
Name:*

First NameLast Name
Title*
Job Title
Phone Number:*
Please enter your personal phone number.
Email:*
Please confirm your email is spelled correctly.
Organization Information:

(Information about your school, institution, or organization.)
Organization Name:*
School, Institution, or Organization Name
Address:*

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number:*
Please enter your entities main business phone number.
Administrator Information:

(Primary point of contact information for the authority who is able to make administrative & financial decisions about implementing new curriculum.)
This information is the same as my contact information.
Name:*

Administrator First NameAdministrator Last Name
Title:*
Administrator Job Title
Email:*
Please confirm your email is spelled correctly.
Phone Number:
Administrator Direct Phone Number
Teacher Information

(Primary point of contact information of who will be teaching this course- additional teachers can be added later if multiple teachers will be implementing.)
This information is the same as my contact information.
Name*

Teacher First NameTeacher Last Name
Email*
Please confirm your email is spelled correctly.
Phone Number
Teacher Direct Phone Number
Pricing Information

(Breakdown of Parenting Essentials Plus costs.)

Price per Learner:	$75(plus shipping for Parent Workbook) $50 per learner + $25 per workbook
Facilitator Training: (1-hour overview of 8 lessons and a facilitator workbook)	$1,000 per facilitator
Technical Support:	10 hours included $100/hour if additional hours needed

Workbook Information

(Information about the number of workbooks needed and shipping address.)
Each Parent/Learner must have their own individual workbook for this course. Please indicate how many workbooks you will need to order below.*
# of workbooks needed, will be added to your order/invoice after this form is completed.
My shipping address is different than the one I listed for my organization above
Please tell us where you would like the workbooks shipped to:

Street Address

Street Address Line 2

CityState

Zip Code
Do you have any additional questions we can answer for you?

0/500
How did you hear about ParenTeach Institute?*
Please provide the name of the HUB Coach who referred you:*
Please list how you heard about us:*
Please tell us who referred you: *
Should be Empty:

Contact Information:

Organization Information:

Administrator Information:

Teacher Information

Pricing Information

Workbook Information