ANGER MANAGEMENT: 4 x INDIVIDUAL SESSIONS – REGISTRATION FORM

I would like to do the anger management program conducted over 4 Individual Sessions. Total $570. I understand that I first need to pay $285 (non-refundable) for the first two sessions which also includes the participants manual. I further understand that I will be contacted for the four individual sessions to be booked at a mutually suitable time. To open a registration form, choose either “Click here if paying via PayPal” ($285 will be deducted) or if you do not have a PayPal account “Click here if paying Later”.

Direct Deposit Details

BANK: Commonwealth
ACCOUNT NAME: SANCTUM
BSB: 06-3215
A/C No: 00326191

    Your Details:







    Who Referred You?:




    Please select the appropriate responses:

    Do you have a Court Order to do this group?

    Do you have an Intervention Order?

    Are you currently living with your partner and children?

    When are you next appearing in Court?

    Registration Process and Conditions:

    By typing my name in the space below and submitting this form, I am confirming that I have read, understood and agree to the Anger Management MANDATORY Participation Agreement.

    I, have read and agree to comply with the above-mentioned agreement.

    I understand that I will be emailed a copy for signing.

    Comments:

      Your Details:







      Who Referred You?:




      Please select the appropriate responses:

      Do you have a Court Order to do this group?

      Do you have an Intervention Order?

      Are you currently living with your partner and children?

      When are you next appearing in Court?

      Registration Process and Conditions:

      By typing my name in the space below and submitting this form, I am confirming that I have read, understood and agree to the Anger Management MANDATORY Participation Agreement.

      I, have read and agree to comply with the above-mentioned agreement.

      I understand that I will be emailed a copy for signing.

      Comments: