8-Week Parenting Class Registration Form

8-Week Parenting Class Registration Form

(This is not a co-parenting class)
Please take a moment to provide us with some information about yourself. If you have any questions, please don't hesitate to contact us at (951) 249-3816.
Your Name:*

First NameLast Name
Email*
Phone Number*
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Please indicate how you would like your name printed on your certificate if different than above.
Are you court-ordered to attend this program?*

YesNo
If court is involved, when is your next hearing?

MonthDayYear
Date
Attorney Information (If applicable):
Is Child Protective Services (CPS) involved in your case?*

YesNo
If yes, please enter your social workers name, email and phone number.
Is there an active restraining order in your case?*

YesNo
How did you hear about us? Facebook, Instagram, Google, Referral, Other.*
Payment

Attention: Once you enter your payment and hit submit, if you see a blank page, please scroll to the top of the page for confirmation or check your email for confirmation. For any questions, please contact us at (951) 249-3816.
My Products
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Full PaymentCovers the entire cost of the class at $45 per session plus the one-time non-refundable registration fee of $35.
$395.00 Quantity

Half PaymentCovers the cost of weeks 1-4 of the class at $45 per session plus the one-time non-refundable registration fee of $35.
$197.50 Quantity

Subtotal

$0.00

Tax

$0.00

Total

$0.00

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.