Parents Find out more about the future Attachment Security Courses by clicking the link below. Click here for course brochure If you pay using the PayPal button below, please include this information in the “Notes to seller” section of the PayPal form:: Parent name(s), address, phone, email, children’s names/ages, DSS Agency & social worker. Thank you!You may pay online using the PayPal button above, or, you can print this form out and mail or fax it to us. Thank you! REGISTRATION FORM Instructors: Somer George & April Hepler Dates: TBA Time: 6:30 – 8:30 pm Location: The Gathering Place, 841 Mount Clinton Pike, Harrisonburg, VA 22802 Course Fee: $795 per person (In some cases, tuition may be paid by DSS). PARENT’S NAME: ________________________ ADDRESS: _______________________________ PHONE: _________________________________ E-MAIL (for each parent): __________________ ________________________________________ DSS AGENCY & SOCIAL WORKER: __________________________________________ FIRST NAME(S) and AGES OF CHILDREN: __________________________________________ __________________________________________ Complete and mail this registration form along with a check payable to: Virginia Child & Family Attachment Center, 1001 E. Market St., Suite 201, Charlottesville, VA 22902 Or fax the form to: 434-328-2953 A full tuition refund will be given for cancellations made at least two weeks before the start date; a 50% refund will be given for cancellations made through the day before the start date; No refund will be made for no-shows or cancellations the day of the training, however, attendance at a future training will be offered.