Parent Management Training Registration

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Please fill out the following information as completely as possible so we are able to ensure that this group is the best fit for your situation. Any questions, please call the office at (989) 340-1466 ext 0.

First and Last Name *

Date of Birth *

YYYY

Address *

Phone Number *

Email *

Do you have a partner that will be attending with you? *

Yes

Maybe

Partner's Name

Partner's Date of Birth

Address

Phone number

Are you able to commit to attend at least 8 out of the 10 sessions that will be held? *

In order for this group to be the most effective, it is very important that you attend the majority of the group sessions. There are an average of 10-12 sessions held. Please note that you will be charged for sessions even if you do not attend.

Yes

Are there any accommodations you may need to participate in the group? If so, please explain:

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