The Counseling Classroom Clubs

The Counseling Classroom Clubs
Parent Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Child Name

First NameLast Name
Age
Gender
School and Grade
What Club are you interested in?
What prompted you to want to sign your child? Please be specific about their behaviors.
Does your child have a therapist?
Is your child on any medications? If yes, which?
What are your thoughts about keeping this group confidential? While by law, as minors I can and will share with you. I would like to know your feelings about it. It is helpful to know this when the children create the group rules on the first day.
What would you love for me to know about your son/daughter?
Each Club runs for 6 weeks. The cost of each Club is $350 and payments can be set up with Katy Anchondo (katy@thecounselingclassroom.com). Please reach out to Katy for any questions or concerns.
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