Individual / parents / couples and group workshops

  

Call 410-271-1009   *   e-mail - mycompassionpower@yahoo.com 

                                                  Mail form to: J. Brooks, 1740 Chesapeake Dr., Edgewater, MD. 21037

Workshops

  

  

  

parents, Indivdual & couples instruction 

Groups are available by special request. Please call to make arrangements.

Employee groups / Church groups / Law enforcement groups / military groups / caregivers for the elderly / 

Prices are based on group size and number of sessions

______________________________________________________________

Please call to make an appointment and make arrangements for time and location

  

  

  

  

 Registration Form for Individuals/ parents / Couples

  

Name:_______________________________________Phone (H)____________(W)____________(C)__________

Address:_____________________________________City_____________________State_______Zip__________

E-mail_______________________________________

__Single   __Married   __Separated   __Divorced   __Widowed

Other than your children.....Do you live alone?  __Yes    __No       If No, who lives with you? ____________________

Number of children______Ages / M/F  1.___/___ 2.___ /___3.___/___ 4.___/___5.___/___6.___/___ 7.___/___

  

Please answer the following questions:  (check all that apply)

1.  Which of the following best describes you most of the time, when relating to your __children __spouse __other 

    ___ (stressful)      ___(frustrated)   ___(angry)   ___(yelling)   ___(power struggles)

2.  Which best describes your __child / children / __spouse __other, most of the time when relating to you?

   ___(stressful)     ___(frustrated)   ___(angry)   ___(yelling)     ___(power struggles)

3.  Which best describes you most of the time when relating to your child / children's other parent? (if applicable)

   ___(friendly)     ___(hostile)      ___(no communication)    ___(power struggles)

How did you hear about our services?   ____________________________________________________________

My form of  payment  will be :  __check   __cash    __money order  __ sponsorship resource   Amount$__________

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