Winter Workshop Registration

Name*

First NameLast Name

Date of Birth*

example@example.com

Parent/ Guardian Name*

First NameLast Name

Email*

example@example.com

Mobile Number*

Workshop/Workshops you are registering for:

Workshops at 8 Johnson St

Dance Movement Group 6-9y/o 12/27 @10amAthletic Performance Anxiety Group 12/27 @11amComic Corner 12/28 @ 10amJournaling Workshop 12/28 @12pm

Workshops at 2281 Victory Blvd

CBT Dreamcatcher Workshop 10-12 y/o 12/27 @11amCBT Dreamcatcher Workshop 7-9 y/o 12/28 @ 11amFashionista 101 Workshop 12/28 @1pm

3710 Richmond Ave

Coping with Divorce 12/14 @5pmWarm & Fuzzies Coping Workshop 12/27 @ 12pmFashionista 101 Workshop 12/27 @2pmVision Board Workshop College Aged 2 parts 12/15 & 12/22Vision Board Workshop 10-14 y/o 12/ 28 @ 11amVision Board Workshop 14-17 y/o 12/28 @12:30pmWishdoll Workshop for College Aged 12/15, 12/20, 12/27

Virtual Workshop

Mindful Eating Workshop 12/12 @6pmNew Years Parenting Resolution Workshop 12/29 @9am

I agree to the below terms & conditions*

I acknowledge and understand that this workshop is not in place of a therapy session. Participation in a workshop does not result in a consistent therapy zone session.

I agree to the below terms & conditions*

I understand that this is workshop is not appropriate for severe mental health treatment, if I am experiencing a mental health crisis please call 911.

Are you currently a Therapy Zone client receiving serives?

If yes, please type your therapist's name below.

The submission of this form does not confirm placement in the workshop. Please check your email for a link to purchase your ticket to the workshop and secure a spot!