Event Sign-up

This form is for community members or clients seeking to participate in our Summer Parenting Workshop Series

After completing this form, please keep an eye on your email for follow-up information.

Event Interest Form

Name

First Name

Last Name

I am interested in:

Email

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

How many will be attending from your household?

Check this box to opt in to text message alerts

Yes, I agree to receive text messages regarding Champion Family Therapy communication

No, I choose to opt-out of texting at this time

Are you a current or former client at Champion Family Therapy?

Please be aware, we are unable to offer cash-pay services to any clients with OHP due to legislative limitations.