Please complete the form below to reserve a spot in one of our parent groups. Once we receive your form, we will e-mail you our intake forms, including a credit card payment form. Please note that your registration is not considered complete until you submit the intake forms.

SIGN-UP FORM

Name

First Name

Last Name

Email

Phone Number

Which group(s) are you interested in attending?

Helping your anxious child, a SPACE informed group - beginning Sat. May 24th

Introduction to Emotion Coaching - Sun. June 8th

Introduction to Emotion Coaching - Sun. July 6th

Number of spots requested

Age of child you are supporting

How can we follow-up with you if needed (check all that apply)

E-mail

By Phone (and I consent to OWPC leaving a voicemail if I'm not available)

By Phone (please do not leave a voicemail)

We look forward to working with you!

Questions? Contact us at:

Telephone: 905-971-0209
Fax: (289) 667-0101
Email: admin@ontariopsychologyclinic.ca

Parent Group Registration

SIGN-UP FORM

We look forward to working with you!