• Preparing for Takeoff Workshop Registration Form

    Preparing for Takeoff Workshop Registration Form

  • Join the Virtual 8-Session Super-Parent Preparation Course

    Registration Fee: $25 per adult registering

    Course Fee:  $50 per week for each parent/caretaker, or $285 when paid up front (5% discount)

    When: Weds., July 9th, 2025 to August 27th, 12-1pm

  • Participant Information

  • Format: (000) 000-0000.

  • Second Adult Joining?

    Please share their contact information below.
  • Format: (000) 000-0000.

  • Child's Information

    Please tell us a little about the child or children you are currently caring for.
  • Is the child currently in therapy or behavioral programming?
  • Are Parents/Caretakers currently in therapy or behavioral programming?
  • Is the child engaging in any self-harm or suicidal behaviors or behaviors that are dangerous to others?
  • Are you court-mandated for parenting classes? (Please note that this program will NOT fulfill any court mandated requirements and we will not provide documentation for court proceedings regarding your participation in this workshop.)
  • How did you learn about this virtual workshop?

  • Payment Information

    • Session fees may be paid weekly or in one lump sum (Save 5%!).  
    • Full payment for all 8 sessions is required even if all sessions are not attended.
    • Participants may request missed information or handouts from the class facilitator
  • Please choose how you would like to be charged:*

  • Hold my Spot!*

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    Registration Fee. This registration fee secures your spot in the course and does NOT count toward session fees. An invoice will be sent prior to the start date of the course for your session fees. If you have more than 2 people registering, please complete another form.
    Registration Fee

    This registration fee secures your spot in the course and does NOT count toward session fees. An invoice will be sent prior to the start date of the course for your session fees. If you have more than 2 people registering, please complete another form.

    $25.00$25.00
      
    Total
    $0.00$0.00

  • By signing below, I agree to the following course requirements:

    • In order to facilitate a safe space in which to share and learn, I agree to keep confidential anything disclosed by other parents participating in this course.  This means that I will attend virtually from a non-public location and use headphones if others are within listening range.
    • I understand that the instructor of this course is a mandated reporter, so statements that indicate abuse of a child may be reported according to state and federal law.
    • I agree to attend as many sessions as I am able to and understand that my participation adds to the experience of all. 
    • If I am unable to attend a session, I will contact the instructor ahead of time to let them know.
    • I understand that I am still responsible for payment for a missed session and that I may request materials from the session.
    • I understand that this course does not consititute a clinical service, is not meant to diagnose or treat a condition, and is not reimburseable by my insurance, but may qualify for payment using an HSA.
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