Parenting Your Gifted or Twice-Exceptional Child
A six week strength-based parenting workshop and discussion group
Registration
Group size is limited to 8 participants. If a group is full you will be notified via email and placed on a waiting list.
6 Wednesdays, 9am—10:30am
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February 5 - March 12, 2025 ($675 for one or both caregivers)
Parent / Caregiver Information
Parent / Caregiver #1 name
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First Name
Last Name
Parent / Caregiver #1 email
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Parent / Caregiver #1 primary phone
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Home address (no PO boxes)
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Street Address
Street Address Line 2
City
State
Postal / Zip Code
Parent / Caregiver #2 name (optional)
First Name
Last Name
Parent / Caregiver #2 email (optional)
Parent / Caregiver #2 primary phone (optional)
Group Participants - Let us know who is registering for this group
Caregiver #1
Caregiver #2
Both caregivers
Please let us know how you were referred.
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Child Information
Child #1 name
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First Name
Last Name
Child #1 date of birth
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Month
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Day
Year
Child #1 age
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Child #2 name (optional)
First Name
Last Name
Child #2 date of birth (optional)
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Month
-
Day
Year
Child #2 age (optional)
Child #3 name (optional)
First Name
Last Name
Child #3 date of birth (optional)
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Month
-
Day
Year
Child #3 age (optional)
Additional Information
What are your biggest parenting challenges?
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What do you hope to learn or discuss during this group?
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What would you like us to know about your child(ren)?
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Is there any additional information you would like us to know?
Required Forms
Financial Responsibility and Attendance Policy
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I understand that PAYMENT IN FULL IS DUE WHEN INVOICE IS RECEIVED to confirm my registration and that this group does not offer refunds, missed sessions cannot be rescheduled, and fees cannot prorated. I understand that I will NOT be charged if I am placed on a waiting list; if a space becomes available, I will be contacted and will have 24 hours to confirm registration.
I understand that Venmo and Paypal are the preferred forms of payment. I understand that a $35.00 service fee will be charged for any checks or payments returned for insufficient funds. I understand that finance charges will accrue at 12% APR if payment is not received in our office within 25 days of the due date, and a minimum monthly finance charge of $15.00 will apply to all overdue payments.
Cancellation and/or Closure Policy
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I understand that all cancellation requests must be made in writing via email to kasiannpeters@gmail.com; if written notice is received more than one week in advance of attendance, I will receive a refund less 25% registration fee.
I understand that there are no refunds for cancellations with less than one week’s advance notice.
I understand that if the group is unable to meet because government officials and health experts do not deem it safe, I will be issued a refund in the amount of the cost of unused sessions.
Payment Information
Please select your preferred method of payment below. Registration is not confirmed until payment has been received.
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Venmo: @Kasi-Peters
Paypal: kasiann@yahoo.com
Check: Kasi Peters, 4015 Lamarr Ave. Culver City, CA 90232
Parent / Caregiver Signature and Date
By signing below, I attest that I understand and agree to the terms and conditions outlined above.
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First Name
Last Name
Today's Date
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