Raising Your Challenging Child Registration | Guiding Exceptional Parents

How many are attending the class?*

Your Name*

First Last

Your email*

Caregiver #2*

First Last

Caregiver #2 email*

Your home phone

Your work phone

Your cell phone*

Children's Information*

Name(s), age(s), issues/challenges (in brief). Please use a separate line for each child.

How did you learn about this class?*

Help keep this program accessible to all. If you pay what you can, you will help support others who can’t pay as much.*

Total

$0.00

Credit Card*

American Express

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

*

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Register for the Spring 2020 Raising Your Challenging Child Class