Therapy Group/Workshop Registration

Important!

If you are a new client or have not filled out the Family Place Intake Form, please complete it before proceeding with additional form submissions. This information is essential for us to provide the best service possible.

Therapy Group/Workshop Registration

Please select the group you would like to register for and provide some basic contact information.

Course^*

First Name^*

Last Name^*

Date of Birth^*

Phone Number^*

Email Address^*