Emotional Coaching Registration Form

Emotional Coaching Registration Form

Thursdays from 5:30pm to 7:30pm February 26-April 30, 2026 Reach Dane 2096 Red Arrow Trail, Madison, WI 53711
Join us for weekly sessions designed to increase awareness of emotions in both your life and your child’s. You’ll learn practical strategies for setting limits, problem-solving with your child, and responding thoughtfully to everyday challenges.

Connect with other parents and caregivers while gaining tools that can make a difference now and help foster a nurturing, supportive relationship with your child for years to come.

Dinner and childcare will be provided.
We want families to attend all sessions but understand that you may have a conflict during these dates. Will there be any dates that you will need to miss?
Participant Full Name*

First NameLast Name
Date of birth

MonthDayYear
Date
Gender

MaleFemaleNon-BinaryPrefer not to Say
Ethnicity

Hispanic or LatinoNot Hispanic or Latino
Race

American Indian or Alaska NativeAsianBlack or African AmericanNative Hawaiian or other Pacific IslanderWhiteMulti-racial
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email Address
example@example.com
Contact Number
Household Information *
Do you need childcare?

YesNo
Childcare during Emotional Coaching

If yes, please include the name and birthdate of each child needing care during the Coaches' Corner
Should be Empty:

Childcare during Emotional Coaching