Workshop Registration Form
Child’s Name Parent/Guardian Name
Date of Birth
mm/dd/yyyy		 School Name
Home Phone
999-999-9999		 Work Phone
999-999-9999
Email Address
Address
City   
State   
Zip   
Indicate workshop requested :
Anger Management
Resiliency with Character Building & Self-Esteem
Decision Making with The 7 Habits of Highly Effective Teens
Truancy & Effective Goal Setting
Parenting
 

 
                                    

General information:
Fee:$45 per workshop (payable with cash or money order made out to LifeSkills Institute)
Hours:Workshops consist of one (4) hour session held on Saturdays from 8:00 AM - 12:00 Noon (Possible afternoon sessions from 12:00 noon - 4:00PM)