Emotional Regulation for Girls
Register your child for our 6 week intensive coping skill builder or get on my list for future workshops
Parent/Guardian Full Name
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First Name
Last Name
Parent/Guardian Email Address
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example@example.com
Parent/Guardian Phone Number
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Please enter a valid phone number.
Format: (000) 000-0000.
Attendee Full Name (Child/Minor)
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First Name
Last Name
Child's Grade
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Please Select
Grade 4
Grade 5
Grade 6
Grade 7
Grade 8
Grade 9
Grade 10
Grade 11
Grade 12
Child's Age
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Please Select
10 years
11 years
12 years
13 years
14 years
15 years
16 years
17 years
18 years
Child's School
Do the attendee have any Allergies or Serious Medical Conditions?
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Yes
No
Please provide details about the allergies or medical conditions
Select a Workshop
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4th-5th grade girls (age 9-12), Tuesdays 4:00-5:00, April 7, 2026 - May 12, 2026
Middle School Girls (age 11-14), Saturdays 3:00-4:00, Apr 4, 2026- May 9, 2026
High School Girls (age 15-18), Sundays 3:00-4:00, April 5, 2026-May 10, 2026
These dates do not work for me, but I want to be notified of future events
If these dates do not work, please write good days and times for you
I give Tara Iagulli, LPC, consent to contact me for further registration details and payment options
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I agree
Parent Signature
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