Co-Parenting 202

Class Time:

Scheduled Time

I agree to:*

Take the Co-Parenting 101 Course for $50Pay $250 per parent for Co-Parenting 202Contact Sue to schedule our first Zoom callCommunicate through the AppClose appDownload ZoomDo Weekly HomeworkSchedule weekly Zoom calls with Co-ParentAttend 2 Live Webinars with Sue and Co-Parent to discuss

Class Day/Time

Saturdays 10am-NoonWednesdays 7pm-9pm

Register:

Co-Parenting 202$250.00

(per parent)

Enter coupon

Total $0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Full Name

E-mail*

Email

Phone Number

Area CodePhone Number

Mobile Numbers Text Message Opt-in

Yes, I agree to receive text messages from Sue Dockerill, Life Works Parenting Tools.

Co-Parent Name (child's other biological parent)

First NameLast Name

Important

I have a protective order or restraining order.

Case Number

Judge

Judge's Name

Restraining order with:

First NameLast Name

Child 1

First NameAge

Child 2

First NameAge

Child 3

First NameAge

Child 4

First NameAge

Additional Children:

Names, Ages

How did you hear about Co-Parenting 202?

Disclaimer*

The components of the parenting course are intended for educational purposes only. The presentation of this material is not intended to constitute mental health therapy, give information on specific mental health disorders nor medications to treat mental health disorders. Participants are encouraged to discuss specific mental health questions with a licensed mental health therapist of their choice.

Legal Disclaimer*

The legal component of the parenting course shall provide general Florida family law principles. The presentation of this material is not intended to constitute legal advice and the course material must direct the participant to consult with a licensed attorney for answers to specific legal questions.

Co-Parenting Agreement

Information will be shared only upon written consent (except where there is risk of harm to self or another person, or as required by law). There is no recoding or posting of content or comments in any form or media by clients or their proxy although Susan Dockerill may record at her discretion for accountability purposes. The service record shall remain the property of Susan Dockerill. Information obtained about persons served will be used for coaching and educational purposes, payment collection and at times, satisfaction surveys. Non-identifying information may be used by Susan Dockerill or statistical, research or educational purposes. Neither Susan Dockerill nor her notes may be called to or used for Court or Arbitration or legal purposes between clients. Consultation may be obtained in order to facilitate appropriate service. No identifying information will be released for this purpose. Client time and billing begins at the scheduled appointment time and ends accordingly. Missed appointments and appointments cancelled with less than 48 hours notice (not including weekends), will be billed to the client for one hour. Service is provided on a fee-for-service basis. Clients agree to pay the amount 250.00 before the 4 session webinar begins by registering at www.lwpt.org Sometimes circumstances arise that require other agreements prior to providing service. These agreements will be specified when appropriate and may be set in writing. Susan Dockerill reserves the right to suspend or terminate service. If you wish for anyone to receive information, your signature is your authorization and consent allowing the disclosure and/or transmittal of information between Susan Dockerill and yourself. Information provided will be personal in nature pertaining to you and/or family and may include, reason for referral, assessment, educational suggestions, progress and consultation. These policies have been explained to me/us and I/we understand them and my/our responsibilities. Further, Susan Dockerill has presented her qualifications, experience and approach to coaching. I/we agree to enter into family coaching for parenting tools with her knowing I/we can terminate coaching at anytime. The fees are non-refundable. I/we agree that this process has been entered into voluntarily.

Signature

Clear

Week 1

Week 2

Week 3

Week 4

Week 5

Week 6

Week 7

Week 8

INSTRUCTOR RECOMMENDATION FOR CO-PARENTING SUCCESS

Continue to monitor all communication on AppClose.com

RecommendedNot Needed

Continue for four more webinar sessions with guided practice

RecommendedNot Needed

Psychological evaluation

RecommendedNot Needed

Graduation Date

Date