Online Forms

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5. Parents Book Club

   Join us for a monthly get-together where we work through some of the best parenting books out there - this time, we're reading The Whole Brain Child by Daniel J. Siegel, M.D. and Tina Payne Bryson, Ph.D.

   We provide the books for you to mark up, dog-ear, and keep for reference!

7. Session Details

   Book: The Whole Brain Child by Daniel J. Siegel, M.D. and Tina Payne Bryson, Ph.D.

   Dates:

   TBD

   Location: Zoom (invite sent via email upon registration) or in-person

9. PLEASE NOTE: during each session, we'll go through two chapters of the book. It is important to be able to attend all four sessions to get the most information!
11. First Name*
12. Last Name*
14. Child(ren)'s First Name(s)*
15. Child(ren)'s Age*
17. Email Address*
18. Phone Number*
20. 2. Do you need support accessing Zoom?

    1. Yes
    2. No
22. 4. Would you like to learn more about additional parent education and support services? *

    1. Yes
    2. No

    Your contact information will be used by the Caregiver Education Coordinator to contact you or share information with you
24. 5. Where do you live?*

    1. Hinton
    2. Edson
    3. Yellowhead County
    4. Other
26. 6. Additional Comments
    (please add any additional feedback here)
28. To participate in this online session, you must agree to protect privacy and confidentiality for yourself and other participants. *

    1. I AGREE I will not share my invitation or password with others
    2. I AGREE I will strive to view this session in a private area
    3. I AGREE I will not record, take screenshots of, or share this session
30. Thank You!

    Thank you for registering for the Parent Book Club Series! Zoom invites will be sent to the email you provided.

Leave This Blank:


32. 1. Receive an email copy of this form.
33. Email address

    This field is not part of the form submission.

34. Submit

* indicates a required field