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Parent Academy Registration
*Please Note* After registering you will be contacted to collect payment in full! No exceptions. Classes are non-refundable.
Thank you!
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Indicates required field
Parent's Name
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First
Last
Email
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Phone Number
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Select One
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Phobias & Fixations
Transitions
Sibling Rivalry
Building Motivation
Manaing Problem Behaviors
Increasing Compliance
DIY: Token Economy Systems
DIY: Increase Socialization
DIY: Visual Schedules
How many attending? (Select One)
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1
2
3 (+$60)
4 (+$60)
DIGITAL CONSENT
I consent to participate in the above named program designed to enhance my skills personal competency in children using strategies from Applied Behavior Analysis (ABA). I understand that the information gathered in sessions will be held confident from sources outside the office, unless I grant written or verbal consent for exchange of information between professional or interested parties regarding the care of my myself and family. I understand that the exceptions to confidentiality include suspected child abuse, a threat to harm oneself, or a threat to harm another person. Since Melmed Center providers work as a team, information is shared with team members on a as needed basis, for the benefit of the child.
During the session, I will participate in activities designed to improve my knowledge of the foundation of ABA. The facilitator encourages us to discuss information that we are comfortable sharing with the group as a time of collaboration and troubleshooting. I understand that sharing personal information is not a requirement of the group and that it is on a voluntary basis.
Since my space in the group is reserved, I understand that I pay for the series of sessions whether or not I am able to attend due to illness, vacations, etc. Individual parent meetings are available for an additional cost if required.
I understand that I am responsible for all fees related to my sessions. Payment, in full, is due at the time of registrations. Melmed Center is happy to provide a statement at no charge of the group meeting for my records.
A
s participants you will be sharing personal information and stories. Cameras are required to be on during class so we can monitor who is present, to protect everyone’s privacy. Thank you for your understanding.
We apologize, but Microsoft Teams Platform does not allow BCC meeting participants on invites, therefore e-mails will be shared among other class participants, once enrolled. This class may be recorded for quality assurance purposes.
Having reviewed the preceding, I consent to the participation in the above named group and agree to abide by the above stated terms and conditions.
Please Type your name as Digital Signature
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Register