Parenting A Challenging Child
REGISTRATION FORM
Pre-registration is required
Fee: $40 per session | $120 for four sessions (2nd parent is free)

To register online:	Check the session(s) you want to attend and then complete the registration form
To register by phone:	Call 508-366-7557

Payment information will be sent with your registration confirmation

Please select the date(s) you would like to attend.

May 4 (Wednesday evening)	7:30 pm - 9 pm	Fee:  $40
June 8 (Wednesday evening)	7:30 pm - 9 pm	Fee:  $40
July 13 (Wednesday evening)	7:30 pm - 9 pm	Fee:  $40
August 10 (Wednesday evening)	7:30 pm - 9 pm	Fee:  $40
September 14 (Wednesday evening)	7:30 pm - 9 pm	Fee:  $40
October 12 (Wednesday evening)	7:30 pm - 9 pm	Fee:  $40
November 9 (Wednesday evening)	7:30 pm - 9 pm	Fee:  $40
December 7 (Wednesday evening)	7:30 pm - 9 pm	Fee:  $40

Please complete the registration form. Click on Register Now! at the bottom when you are finished.

First name:
Last name:
Street address:
City:		State:		Zip:
Email address:
Check here if you would like to be added to our email list to receive future flyers, parenting tips, and more!
Home phone:
Work phone:
Cell phone:

 

If a second parent is attending, please provide the following information:
Full name:

 

Please select the payment method you will use:
I will mail payment in advance. I will pay with cash or by check at the session.
If you are paying in advance, please send payment to:
	Sylvia Sirignano, Ph.D. Parenting Solutions 6 Colonial Drive  Suite 2 Westborough, MA  01581
How would you like to receive confirmation of your registration?
Send confirmation by emailSend confirmation by mail
Feel free to provide any additional information.

Please go Back to the Top and review all information prior to submitting your registration.

If you are ready to register please print this page for your records.

When you are ready, click below to send us the registration form. Please be patient, your registration may take a few moments to process.