Circle Of Security Parenting Group Registration

Circle Of Security Parenting Group Registration
Registration, Payment, and Cancellation Policy

1. Registration & Enrollment
- Enrollment is first-come, first-served and space is limited.
- A participant’s spot is not guaranteed until full payment is received.
- Registration is considered complete and binding upon payment.
2. Payment Policy
- Full payment is required at the time of registration to reserve a spot.
- Payment confirms commitment to the full 8-week program.
- No refunds or credits for missed sessions or early withdrawal
- This session is offered as private pay (out of pocket) service. Private insurance will not be billed.
3. Attendance & Participation Expectations
- This is an 8-week structured program, and consistent attendance is important for success.
- Missed sessions:
  - Are not refunded
  - Cannot be made up unless otherwise specified
- If a session is cancelled by the Instructor (due to illness, etc.) a make-up session will be offered.
Parent Name (Enrollee)

First NameLast Name
Patient Name

First NameLast Name
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Is your child on Medicaid or CHP+?
How Many People Will Be Attending

By registering for the program, participants acknowledge that they: Understand and agree to all payment and cancellation terms Are committing to the full 8-week experience and that Private Insurance will not be billed.

8 Week Parenting Class

$500.00

Total

Credit Card

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