Taming Your Worry Dragons - Request to Register This form is to request registration for your child in the upcoming Taming Your Worry Dragons program. Registration requests may be denied if your registration was received after all available spots have been filled, or after the registration cut-off date. In this case your credit card will not be charged and you will be contacted. If your child has successfully been registered for the program, you will receive booking confirmation emails, as well as an emailed intake form and receipt of your payment.Please allow 1-2 business days for your request to be processed.How many children will you be registering?*OneTwoThreeFourParticipant #1Participant #1 Name* First Last Participant #1 Age*Grade 3Grade 4Grade 5Grade 6Grade 7Grades 3-5This child will be registered for the 3:45-4:45 PM class.Grades 6-7This child will be registered for the 5-6 PM class.Participant #2Participant #2 Name* First Last Participant #2 Age*Grade 3Grade 4Grade 5Grade 6Grade 7Grades 3-5This child will be registered for the 3:45-4:45 PM class.Grades 6-7This child will be registered for the 5-6 PM class.Participant #3Participant #3 Name* First Last Participant #3 Age*Grade 3Grade 4Grade 5Grade 6Grade 7Grades 3-5This child will be registered for the 3:45-4:45 PM class.Grades 6-7This child will be registered for the 5-6 PM class.Participant #4Participant #4 Name* First Last Participant #4 Age*Grade 3Grade 4Grade 5Grade 6Grade 7Grades 3-5This child will be registered for the 3:45-4:45 PM class.Grades 6-7This child will be registered for the 5-6 PM class.Contact InformationFor parents or guardians.Name of Primary Contact* First Last Cell Phone of Primary Contact*Email of Primary Contact* Name of Secondary Contact* First Last Cell Phone of Secondary Contact*Parent/Guardian InformationPlease note the following required parent participation dates. At least one parent must be present at each of these dates. Children are not to join on these dates.Parent/Guardian Participation Dates*February 25 | Group parent meeting, during program hours March 17-24 | One private appointment, to be booked with the instructor in advance April 28 | Group parent meeting, during program hours I certify that one parent or guardian will be present for each of these dates. I understand that children are not to attend on these dates.Cancellation/Refund Policy*Refunds will only be given up to 2 weeks prior to the start of the program. After this period, no refunds will be given. This group program is offered as a whole. Refunds or rescheduling will not be available for missed classes. I agree to the cancellation/refund policy.Credit Card InformationIf your registration request is accepted, your card will be charged a one-time fee for this registration. You will be emailed a payment receipt.If spots are no longer available your card will not be charged, and you will be contacted.Name of Cardholder*Account Type*VISAMastercardAMEXAccount Number*Expiration Date*Please enter in "01" for the expiration day. 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I authorize Alongside You to charge my account for services rendered. I certify that I am an authorized user of this credit card and that I will not dispute the payment with my credit card company; so long as the transaction corresponds to the terms indicated in this form.Signature*CAPTCHA
