Caregiving Your Emotionally Intense ChildGroup Confirmation FormPlease submit the form below to confirm your wish to participate in the CEIC group class beginning in April.Your Name (Caregiver):(Required) First Last Will you be participating in the Caregiving for your Emotionally Intense Child group beginning in April 2023?(Required) Yes NoDo you have a partner who will also be attending the group?(Required) Yes NoYour Partner's Name(Required) First Last Your Partner's Email(Required) If there are two parents participating, please indicate whose name you would like invoices made out to:(Required)What is the name of the child you are attending this group to support:(Required) First Last What is the age of the child you are attending this group to support(Required)Given the demand, an alternate time slot was added for this group. Are you available to participate in a group on Mondays at 10 AM (EDT)?(Required)*Please note that indicating your availability does not guarantee you will be placed in this group time. You will receive confirmation of your group time after the break. Yes NoIf you have any questions or comments, please don't hesitate to ask (optional):
