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Center for Responsive Schools, Inc.
One-day Workshops 2019/2020 Registration Form
To register, please complete this form and submit it with your preferred method of payment. To
register multiple people, complete a copy of pages 1 and 2 for each individual who wishes to attend,
plus one copy of “Payment Information” (page 3) for the whole group.
Participant First Name _______________________ Last Name ___________________________
School ________________________________________________________________________
District _______________________________________________________________________
Position ____________________________________________ Grade Level(s) ______________
Email _________________________________________________________________________
Lunch will be provided. Please indicate any dietary restrictions:
Vegetarian Dairy-free Gluten-free No Peanuts/Tree-nuts
How did you hear about this workshop?
Social Media Direct Mail RC Website Referral Other______________
The following workshops have a mandatory prerequisite of having completed the
4-day Elementary Core Course (RCC-E) or Middle School Course (RCC-M):
Responding to Misbehavior
Improving Teacher and Student Language
Addressing Middle School Challenges
In order to register for any of the above workshops, indicate when and where you took RCC-E or RCC-M:
Location _____________________________________ Date_________________________
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Please indicate your workshop choice by checking the box corresponding to your desired
location/date and workshop.
Note that not all workshops are offered at all locations!
Fall/Winter 2019
Location
Date
IRC
RMB
TSL
SAT
SPB
LDR
West Lebanon, NH WENH20
Oct. 8
th
Seattle, WA SAWA20
Oct. 11
th
Newark, DE NWDE20
Oct. 17
th
St Paul, MN SAMN20
Oct. 18
th
Kansas City, MO KNMO20
Oct. 23
rd
Los Angeles, CA LSCA20
Oct. 25
th
Ann Arbor, MI ARMI20
Oct. 29
th
Aurora, CO AUCO20
Nov. 1
st
Charlotte, NC CHNC20
Nov. 8
th
Waltham, MA WLMA20
Nov. 19
th
New York, NY NCNY20
Dec. 6
th
Chicago, IL CNIL20
Dec. 10
th
Chevy Chase, MD CCMD20
Dec. 13
th
Winter/Spring 2020
Location
Date
IRC
RMB
TSL
SAT
SPB
LDR
MSC
Orlando, FL OLFL20
Jan. 14
th
Austin, TX ATTX20
Jan. 28
th
Atlanta, GA ALGA20
Jan. 31
st
Hartford, CT HFCT20
Feb. 4
th
New York, NY NKNY20
Feb. 7
th
Oakland, CA OKCA20
Feb. 11
th
Columbus, OH CUOH20
Feb. 25
th
Waltham, MA WHMA20
Feb. 28
th
Lafayette Hill, PA LAPA20
Mar. 6
th
Chicago, IL CGIL20
Mar.13
th
Workshop abbreviation key:
IRC = Introduction to Responsive Classroom for K-8 Educators
RMB = Responding to Misbehavior
TSL = Improving Teacher and Student Language
SAT = Special Area Teachers
SPB = Strategies to Prevent Bullying
LDR = Leadership Seminar
MSC = Addressing Middle School Challenges
Our website is updated frequently as classes fill. We suggest checking our website before submitting your
paperwork to see if space is still available. If your first choice is full, we would be happy to put you on a waiting
list or you may select another site.
FULL
FULL
FULL
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Schools outside of the U.S. may also pay via wire transfer. To use this method please contact
our office for details. You will also need to pay an additional 26 USD wire transfer fee.
Payment Information
Workshop
Price per
person
Number of
Participants
Total
Introduction to Responsive Classroom for K-8 Educators
$199
Responding to Misbehavior
$249
Improving Teacher Student Language
$229
Special Area Teachers
$229
Strategies to Prevent Bullying
$229
Leadership Seminar
$199
Addressing Middle School Challenges
$229
Grand Total
Contact name ______________________________ Phone __________________________
Email address ______________________________________________________________
To register participants, we must receive one of the following:
Copy of an official school/district purchase order
I am including a signed copy of purchase order number __________________________
Check made payable to “CRS, Inc.”
Check number _____________________ is enclosed
Request for application of a CRS credit on account (credit memo)
Apply available credit on account from Credit Memo number ______________________
Wire transfer
For payment via credit card (MasterCard or Visa), use our secure online payment process. To learn more, visit
www.responsiveclassroom.org/how-to-register/
Email, mail, or fax this form, along with payment or purchase order, to:
Center for Responsive Schools, Inc.
85 Avenue A Email: registration@responsiveclassroom.org
P.O. Box 718
Turners Falls, MA 01376 Fax: 877-206-3952
We will confirm registration using the participant(s) email within 3 business days after we have received this
completed form and payment or purchase order. Please do not consider participants registered until a
confirmation email has been received.
Cancellation Policy:
30+ days in advance: you are eligible for a refund of your tuition less a 10% handling fee, or a full credit on
account. Less than 30 days in advance: you are eligible for a full credit on account.
*Please note that all credits expire one (1) year from the date that they are issued.*
For the full cancellation policy, visit our website at www.responsiveclassroom.org/cancellation-policy/
Questions? Email registration@responsiveclassroom.org or call 800-360-6332 ext. 130