Workshop Registration 2

Workshop Registration

* Indicates required field

Parent/Guardian Name *

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Last

Parent/Guardian Email *

Parent/Guardian Phone Number *

School District *

Address *

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Line 2

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State

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Parent/Guardian Relationship *

Age(s) of child/children *

Program Confirmation *

I confirm that I am registering for the Understanding and Managing Anxiety in Children Workshop which will be held at the NSYC Rec Room, located in the portable building on the grounds of the Joseph A. Edgar School in Rocky Point, on Monday, November 4th from 6:30-8:30PM. The cost of the program is $40 per person.

Please review our workshop policies and procedures. By signing this document below, I acknowledge that I have read, understood, and agree to adhere to the workshop procedures and policies outlined above. I agree to participate in the workshop and accept the terms as stated. I understand that this registration is not complete until submitted and payment is completed.

Electronic Signature *

Today's Date *

I agree to receiving marketing and promotional materials

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After submitting the above registration form, please complete payment by following the steps below:

Workshop Registration Fee: Understanding and Managing Anxiety in Children 11/4/24

$40.00

Workshop Registration Fee: Understanding and Managing Anxiety in Children 11/4/24

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North Shore Youth Council is a 501(c)(3) not-for-profit community-based organization, funded in part by the Town of Brookhaven, the County of Suffolk, the State of New York, the North Shore Consortium, and public and private donations.

Phone: 631-744-0207

Fax: 631-744-3565

P.O. Box 1286, Rocky Point, NY 11778

Main Office Hours: Mon-Fri, 9am to 5pm

Visit us in the portables on the grounds of the
Joseph A. Edgar School in Rocky Point.