Confident Solutions, LLC I am signing up for:

Jan. 28th-March 4th : This Class is Full. Social Communication $225.00 1:00-2:00

Jan. 28th-March 4th: _________Mindful Thinking & Zones of Regulation $225.00 1:00-2:00

Today’s Date: ______________________________

Child’s Name: _______________________________ Date of Birth:____________________________

School: ____________________________________ Grade:_________________________________

Parent’s or Guardian’s Names:___________________________________________________________

Please provide any new information: ____________________________________________________

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Cancellation Policy: Due to prior preparation and maintaining a small class size to better serve our families, payment in full is due upon registration for the class. If Confident Solutions cancels any sessions due to inclement weather, a make-up session will be offered.