Emotion Coach Study Group Registration Form

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Participant Name* This field is required.
First Name
Last Name
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Email* This field is required.
example@example.com
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Phone Number* This field is required.
Area Code
Phone Number
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Preferred Language* This field is required.
English
French
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If you are a Brossard resident, please provide your B-citi number
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Age of your child/children* This field is required.Infant, toddler, pre-school child, middle school age child, teenager, adult
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How did you hear about the Emotion Coaching Study Group?* This field is required.Social media, website, friend, etc.
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Emotion Coaching Study Group Expectation* This field is required.What do you hope to get out of your participation? Do you have any area of curiosity from the Emotion Coaching training you would like to explore together in the study?
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Every participant is required to have their own copies of Emotion Coaching material from the Gottman Institute to participate in the study group.* This field is required."Raising An Emotional Intelligent Child: The Heart of Parenting" by John Gottman Or https://www.gottman.com/product/emotion-coaching-the-heart-of-parenting-online/
I have a copy of "Raising An Emotionally Intelligent Child by John Gottman"
I have a physical copy of the Gottman Emotion Coaching handbook
I have the online training and a digital copy of the handbook through the Gottman Institute
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Your attendance and participation are very important to the group dynamic. We encourage you to inform the group regarding any changes to your attendance in advance. Thank you for your consideration! We look forward to our time together.* This field is required.Study Group Attendance
I understand my attendance and participation are important
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This study group is a peer learning space for parents participating in Gottman Emotion Coaching training, where we review content, share ideas, and support one another in applying these concepts in everyday parenting.* This field is required.Study Group DIsclaimer
I understand this is a learning space
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It is not a therapy group and does not provide psychological treatment, diagnosis, or individualized advice, and participation does not establish a therapist-client relationship. Parents are encouraged to seek professional support for concerns beyond the scope of this group.* This field is required.Study Group Disclaimer
I understand this is not a therapy group
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Please note that facilitators are mandated reporters, and any suspected or disclosed child abuse or neglect will be reported in accordance with applicable laws.* This field is required.Study Group Disclaimer
I understand any disclosure of child abuse or neglect is taken seriously
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To ensure a healthy study group, we ask all participants to be kind and respectful of the study group rules.* This field is required.
I agree to be respectful and kind in the group
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Today's Date* This field is required.
Date
Month
Day
Year
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The registration fee for one participant is $65 for 10 (1 hour group discussion) and $100 for both parents. The registration fee is only refundable if you are unsatisfied after attending one study group.* This field is required.One of our organization’s missions is to foster a community of parents becoming Emotion Coaches together. If you are interested in supporting this mission financially, we welcome donations through our website.
I am paying for myself
I am paying for both parents
My partner has completed the payment for me through their registration
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If you are paying for two, please write your partner's full name.
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Emotion Coaching Study Group Registration* This field is required.Please select the correct payment.
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