Ketner Counseling Group: Group Registration

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Please complete this form to register your child for a K-5th Grade Spring Group. Upon completion of this registration form you will receive an email with an intake packet and an invoice for the group registration fee to complete the process. The group fee is $180 for the six week session. There will be a maximum of 10 children per group for each section. Please complete a separate form for each child you are registering. Please submit this form by April 3rd. Please call Jessica Ketner at 614-214-1631 or send an email to Jessica.Ketnerimft@gmail.com with any questions.

Parent or Guardian name(s)

Parent or Guardian email

Parent or Guardian Phone Number

Child Name

Child Age and grade in school for the 2023-2024 school year (Age, Grade)

Which Group are you registering for (click all that apply)

SuperSibs! (New Members) (K-5): Sundays 3:15p-4:00p

Cool, Calm and Connected (K-5): Sundays 4:15p-5:00p

Transitioning to Middle School (K-5): Sundays 5:15-6:00p

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