REGISTRATION FORM                                Circle of Security Parenting 
8 Week program for parent/caregivers:
Sunday's, 6:30-8:30pm
April 7 - June 2 (no session May 19)
Facilitated by Kira Charanduk and Anusha Lalani

Program Cost: 525.00

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Email *
Thank you for your interest in this program. Please fill out this registration form. Our admin team will contact you after it is submitted to answer any questions and complete your registration. 
Full Name *
Address *
Phone Number  *
Is this you first experience of attending a mental health and wellness program (group or workshop)? *
Required
Are you currently receiving (or have in the past) individual counselling services? 

Note that this is not required to participate in a program and if you are not comfortable sharing, that is OK. We ask because the facilitators find it helpful to know if participants have other mental health supports in their lives.
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