Question Title

* 1. What is your first and last name?

Question Title

* 2. I understand that my monthly supervision may not be enough to cover my supervision needs and that I am responsible for making sure that my supervision needs are met.

Question Title

* 3. I agree to stay in compliance with all governing boards that oversee my work with children.

Question Title

* 4. I agree to maintain current malpractice insurance.  If for some reason, I do not need to carry my own insurance I agree to discuss this with my supervisor.

Question Title

* 5. I understand that my deposit secures my spot in the Certification Program and understand that if I withdraw my participation before the program begins that I will forfeit the deposit amount.

T