No-Cal Parent Workshop Registration August 27, 2011

Second Nature Parent Workshop Registration

Burlingame, California
Saturday, August 27, 2011
10:00 a.m. to 3:30 p.m.

LOCATION: San Francisco Airport Marriott Waterfront
1800 Old Bayshore Highway
Burlingame, CA 94010

Special lodging rate of $129 is available (limited basis) - simply mention "Second Nature Parent Workshop" when you call to reserve a room!
1 650-692-9100

Your Name(s)

Your email:

Your Child's Full Name

Your Child's Birth Date

Is your child currently enrolled at Second Nature?

Approximate dates/year of attendance:

Second Nature Program your child is currently attending or did attend:

• Second Nature Cascades
• Second Nature Blue Ridge
• Second Nature Footsteps
• Second Nature Entrada
• Second Nature Entrada/Adults
• Second Nature Uintas
• Second Nature 360

Your child’s Second Nature Therapist:

After Second Nature, your child:

• Returned home
• Attended aftercare program
• Other

Please enter the aftercare program or explain "Other".

Number attending workshop:

Please share with us what you hope to gain by attending the workshop:

*PLEASE NOTE

This is a free workshop! We will break for lunch at noon. Cost of lunch is not included but will be offered in the hotel’s café.

Questions? Please contact: familyservices@snwp.com

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