Ongoing Teen Group Today's Date* MM slash DD slash YYYY Child's Name* First Last Child's Date of Birth* MM slash DD slash YYYY School Name* Current Grade*Child's Cell Phone # (if applicable)Chilld's Email (if applicable) Mother's Name* First Last Father's Name* First Last Mother's Phone Number*Father's Phone Number*Mother's Email* Father's Email* Parent's Relationship Status* Is there a topic you would like for us to cover in order to specifically benefit your child? Explain.Payment* I agree This group is $250 for the entire month, which is the equivalent to ONE individual session with one of our therapists. We facilitate it weekly (with a break during the Holidays) and your child is welcome to attend as many sessions a month as he/she would like. For payment please call or text 786-553-4869 or Venmo @Betsy-Guerra-1
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