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Living Room: 10 month Group for Mothers of All Ages & Stages
Welcome! This is the registration form for the 2020-2021 Living Room Cohort. We will be meeting monthly (see dates below) from 3pm-5:30pm on Fridays via Zoom. Part I of registering takes place by filling out this form. Part 2 is necessary to secure your spot.That is sending payment in. Please see the directions below. The 2019-20 year has been a year like no other. Having one another has been really amazing, especially during this time. So glad you can join us for this coming year!!
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Email
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Your email
First Name
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Your answer
Last Name
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Your answer
Email Address
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Your answer
Primary Phone Number
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Your answer
Names and Ages of Child/Children
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Your answer
I would like to sign up for Living Room Sessions and have noted the following dates for the 2020-21 calendar year: 9/25, 10/16, 11/13, 12/11, 01/08, 02/19, 03/12, 04/16, 05/21, 06/18. We will be meeting from 3pm-5:30pm each session.
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Yes
Other:
I recognize that these dates are the planned ones. In some circumstances Natashia may need to change a date. In this case I understand she will give at least one month's notice.
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I understand.
I understand that signing up for the group means I will do my best to attend as many of the sessions as possible, as this helps the group bond and build trust.
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Yes
Other:
I am signing up for this group to make space for myself to...:
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Your answer
I understand that filling out this form is the first step of a two part process to register for the Living Room 2020-21 cohort. I will secure my space by pressing "send" to this form and then sending payment of $500 to Natashia via Venmo (recipient name:
natashiamft@gmail.com
) or sending payment via Paypal (same email addy). One difference with Paypal is to sign up with friends-family or if choosing "business" add $15 to your total, to cover the surcharge Paypal deducts. I will know my spot is secured when Natashia has confirmed receiving both this form and payment. Below I am indicating how I will be sending payment.
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Your answer
Please note scholarships and payment plans are available. If you would like to add an amount for our scholarship fund, please note below how much additional you will be adding. If you would like to inquire about a scholarship or payment plan, please indicate below and follow up with an email to Natashia (
natashiamft@gmail.com
).
Your answer
Cancellation Policy: If you need to cancel your registration for this group, notifying Natashia by August 15th will result in full refund. Notification prior to September 1st will result in 50% refund and beyond that no refund will be possible.
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I understand
Please share any additional info regarding yourself and/or your family structure/circumstances or what you are looking to get out of the group that you think may be helpful for you to share and for Natashia to know. This will be kept confidential.
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