Ongoing Teen Group Regristration – Better With Betsy

Today's Date*

Child's Name*

First Last

Child's Date of Birth*

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