FREE Parenting Teens Virtual Workshop
(Introduction to our full workshop)
2022 Workshop will be announced

Complete Parenting Teens Workshop (4 sessions)
Facilitated by Dr Dee - Clinical Psychologist Akeso Crescent Clinic
Randburg, Johannesburg, South Africa

Full Workshop Costs:
Four sessions = R2 600 (R650 per session)
An early bird special rate of R2 200 is available from the

ONLINE REGISTRATION:

Upon submission you will receive confirmation of your registration.
We will then send you the required details for payment.

1. Delegates Information
Title:	Please select Prof Dr Mr Mrs Ms Miss
Full names:
Marital status:	Please select Married Single never married Divorced Widow
Contact no.:
Alternative contact:
Email address:
Physical address:
Highest level of education:
Occupation:
Relationship to teenage child:
2. Teenage Child’s details
Age:
Gender:
Birth order in family:
Grade:
School name:
3. Person responsible for the account
Title:	Please select Prof Dr Mr Mrs Ms Miss
Full names:
Contact no.:
Email Address:
Relationship to teenage child:
4. Medical Aid
Medical aid name:
Medical aid number:
Main member name:
Date of membership:
Dependent code:
5. I hereby undertake to be personally liable for the settlement of this account if the person responsible or/and the medical aid fails to do so
Full name:
Identity number / Passport number:
Date:
6. Documents required with registration: Please email to info@parentingteens.co.za
Proof of residence:	Please select Yes No
ID certified copy (less than a month):	Please select Yes No
Copy of the medical aid card for participants whose sessions will be claimed from medical aid:	Please select Yes No
Kindly note that when claiming through medical aid, you are still liable to pay for the levy amount upfront for the four sessions if there is a discrepancy between the workshop fee and the rate paid by the medical aid. Please note that you will not qualify for the early bird special rate
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