REGISTRATION FOR PARENT WORKSHOPS with Cindy Goldrich, Ed.M., ADHD-CCSP and Instructors Nationwide Attend In-Person or via Live Webinar Registration Form: MASTER: IN-PERSON & WEBINAR PARENT WORKSHOPS CHOOSE LIVE WEBINAR OR IN-PERSON WORKSHOP*Select OneIN-PERSON in BOULDER, CO with Cindy GoldrichLIVE WEBINAR with Cindy GoldrichInterested in a Different Location? Please email us more additional locations or consider taking our Live Webinar with Cindy or our On-Demand eCourse!CHOOSE AM or PM SESSION*Select OneAM Session: 10AM - 11:30AM Mountain Time</BR>(Sess 1 ends 12PM)PM Session: 5:30PM - 7PM Mountain Time</BR>(Sess 1 ends 7:30PM)AM Session: 10AM - 11:30AM Mountain Time(Sess 1 ends 12PM) PM Session: 5:30PM - 7PM Mountain Time(Sess 1 ends 7:30PM)CHOOSE 1 or 7 SESSIONS and 1 PERSON OR COUPLE, IN BOULDER, CO*Select One1 PERSON Session 1: In-Person1 PERSON 7 Sessions: In-PersonCOUPLE Session 1: In-PersonCOUPLE 7 Sessions: In-PersonSESSION 1:Learning, Motivation, & Behavior: Impact on Kids with ADHD and Executive Function Challenges©October 2, 201910AM - 12PM & 5:30PM-7:30PM Mountain Time 7 SESSIONS:Calm & Connected: Parenting the Child You Have©Oct 2, 16, 23, 30, Nov 6, 13, 20, 201910AM - 11:30AM & 5:30PM-7PM Mountain Time (Session is 2 Hours) LOCATION: You will receive in an email upon registration. CHOOSE SESSION 1 or 7 SESSION via LIVE-WEBINAR*Select OneSession 1 via Live Webinar7 Sessions via Live WebinarSESSION 1:Learning, Motivation, & Behavior: Impact on Kids with ADHD and Executive Function Challenges© 2-Hour WorkshopOctober 2, 201910AM - 12PM & 5:30PM-7:30PM Mountain Time 7 SESSIONS;Calm & Connected: Parenting the Child You Have©Oct 2, 16, 23, 30, Nov 6, 13, 20, 201910AM - 11:30AM & 5:30PM-7PM Mountain Time (Session is 2 Hours)EMAIL US:PTS Coaching Live Workshop/WebinarIf you have a coupon code, please enter it here. Total Registration Fee $0.00 Registration InformationName of Parent(s)* First Last Email Address* Enter Email Confirm Email State/Country* State / Province / Region AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Phone*How did you hear about the workshop?*Select one:Social MediaPTS Coaching EmailWebsite SearchProfessional ReferralFriendOtherPlease specify:*Select One:*FacebookInstagramLinkedInTwitterYouTubePinterestChild's Grade (please check all that apply)* Primary (grades Pre-K-2nd) Elementary (grades 3rd-5th) Middle (grades 6th-8th) High School (grades 9th-12th) College Taking Course as a Professional Credit Card American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20192020202120222023202420252026202720282029203020312032203320342035203620372038 Expiration Date Security Code Cardholder Name For Additional Information or Questions Please Email Cindy@ptscoaching.comCoaching Process and Disclaimer Agreement Coaching is designed to guide the Client to learn how to consistently achieve results and make purposeful choices. Client agrees to communicate honestly, be open to feedback and assistance and create the time and energy to participate fully in the coaching program. However, due to the subjective nature of the work, Client understands and agrees, that the Coach makes no guarantee as to the results Client will achieve, nor is the Coach responsible for the results achieved by the Client from the coaching. Client understands that coaching is NOT therapy and is not a substitute for therapy if needed, and does not prevent, cure, or treat any mental disorder or medical disease. Emergencies: If there is a medical emergency- physical or psychological, DO NOT CONTACT THE COACH’S OFFICE. Emergency issues must be addressed directly by your doctor or therapist, or by dialing 911 emergency services if warranted. Confidentiality and Privacy Agreement: In order to make this service enjoyable and therapeutic for all who participate, it is necessary that both Coach and Client agree to abide by all the rules listed below. Coach agrees to maintain complete anonymity of all Client information disclosed or received from any third party unless permission is received. If it is necessary for the Coach to gain access to information from schools, therapists, physicians or other professionals, Coach will provide a standard information release form for signature by the Client. However, the terms of anonymity shall not apply where failure to disclose may be, in the Coach’s sole discretion, in violation of any law or may involve information regarding certain crimes that have either been committed or Coach believes may be committed, or when such information is subject to subpoena. Coach and Client agree that Group is a safe space for members to exchange ideas, opinions and comments in support of each other and their shared concerns. During Client membership in a PTS Coaching Group Client may learn personal and confidential information about individuals who participate or are involved with this Group. Whether information is available to Client through the Group or accidentally, Client agrees to maintain confidentiality and not reveal information to any person in the Group or outside the Group while Client is a Member of the Group or at any time in the future when Client may no longer be a Member of the Group. Client understands that breaking this agreement could result in the termination of Client’s membership with the PTS Coaching Group. Although good faith efforts have been taken to preserve participant confidentiality, PTS Coaching makes no guarantees in this regard or to information communicated by and between participants in this forum. This provision (privacy) will survive expiration or termination of the Agreement. This Agreement constitutes the entire agreement of the parties, and reflects a complete understanding of the parties with respect to the subject matter and supersedes all prior written and oral representations, communications or agreements. The parties agree that this Agreement shall be deemed to have been signed and performed in the state of New York; and the laws of New York will control herein. IN WITNESS WHEREOF, the Parties have duly executed this Agreement. Consent to Terms* I have read, understand, and agree to the terms within the Coaching Process and Disclaimer Agreement PTS Coaching Newsletter*I Understand that by registering for this course, I will be added to PTS Coaching's mailing list so that I receive pertinent information. I know that I may unsubscribe at any time. PTS Coaching respects my privacy and does not share my email with anyone.Total Registration Fee $0.00 PhoneThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.