Interest Form for: Raising Kids With Big Baffling Behaviors: A Parent Course
Parent/Caregiver Details:
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
example@example.com
I give permission for Benjamin McCormack, LCSW, RPT to email me about the parenting course:
Yes
No
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
I would would like to sign up for Raising Kids With Big, Baffling Behaviors: A Parent Course and would be available at the following time(s):
Sunday's anytime from 10:00 am-1:30 pm (virtual)
Sunday's 10 am-11:15 am In person
Saturday's at 8:00 am-9:15 am virtually
Anything needing clarification (optional)
Benjamin McCormack, LCSW, RPT, offers flexible payment plans to make the 12-week parent course accessible to all families. The total cost of the course is $300, which includes 12 weekly group sessions at $25 each. Each group meets for 1 hour and 15 minutes, totaling 18 hours of instruction. Please note: No payment or invoice is due at this time.
Pay in weekly installments: $25 non refundable deposit at registration, followed by eleven payments of $25 during the 12-week course
Pay in two installments: $25 non refundable deposit at registration, followed by two payments of $137.50 during the 12-week course
Pay in one installment: $25 non refundable deposit at registration, followed by one payment of $275 during the 12-week course
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