5P-Co-Parenting Group (THU)

CO-PARENTING GROUP
Thursdays @ 5:00 PM
Have you participated in a Richstone class or program before?

YesNo
If this is your first class, you must call (310) 970-1921 to get the additional forms needed to complete your registration.

New students will not be admitted into class if all registration and consent forms have not been submitted.
Name*

First NameLast Name
Email*
example@example.com
Cell/Mobile Phone Number

Area CodePhone Number
Verify Current Address*

Street Address

Dirección de la calle línea 2

CityState

Zip Code
For the safety and privacy of all tele-group and class participants, please carefully read and agree to the following guidelines. Violation of these guidelines will result in immediate removal from the tele-group.

No driving or traveling during a tele-group session. Participants must stay in one location for the duration of the tele-group.
I agree and understand (initial)*

Clear
Please Initial
No drinking alcoholic beverages or consumption of cannabis or taking drugs during a tele-group session.
I agree and understand (initial)*

Clear
Please Initial
No recording or taking screen shots.
I agree and understand (initial) *

Clear
Please Initial
understand that I will need to verify that I am in a confidential location at the start of each tele-group session.
I agree and understand (initial) *

Clear
Please Initial
I understand and confirm that there are no other children or adults in the room with me during the tele-group session. (Headsets are recommended)
I agree and understand (initial) *

Clear
Please Initial
I understand that the group/class will be closed 5 minutes after the start time. I agree to be on time.
I agree and understand (initial)*

Clear
Please Initial
Upon completion of this course I will be sent a link via email to complete a satisfaction survey.
I agree and understand (initial)*

Clear
Please Initial
Signature*

Clear
Date*

MonthDayYear
Fecha
- La confirmación de su registro pagado se envía automáticamente al instructor -
Should be Empty:

CO-PARENTING GROUPThursdays @ 5:00 PM

CO-PARENTING GROUP
Thursdays @ 5:00 PM