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Students Conquering Anxiety Mini Group
May 8th, 15th, 22nd, 29th | 4-5PM | Ages 6-13
Parent/Guardian Contact Information
Parent/Guardian Name
*
First Name
Last Name
Parent/Guardian Phone
*
Parent/Guardian Email
*
Verify Email
*
Address
*
Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
Country
Student Information
Student Name
*
First Name
Last Name
Student Date of Birth
*
(mm/dd/yyyy)
Student Current Grade in School
Payment
You will be directed to a PayPal payment service. You do not have to use a PayPal card or have an account. You may use any debit/credit card payment you would like.
Registration/Payment
$80