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Registration - Youth Program Registration
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Youth Program Registration
STUDENT DATA
Name
Gender
Street Address (including apartment number)
PARENT/GUARDIAN DATA
Name
Home Telephone
Email
CAMPUS PARKING
Parking
License Plate Number
I am financially responsible for all program costs for
Program access is available for one year from the date of purchase.
This is designed to be a seven-week program. To receive the most benefits, please follow the seven-week schedule.
The goal of this educational program is to teach children and teens how to recognize negative thought patterns, and provide cognitive behavioral skills and techniques that can be useful in modifying negative thinking.
Students must be 13-years of age or older and live in the United States or it’s possessions, Canada, Australia or New Zealand to access this program.
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