Date: March 20th 2009

CHESAPEAKE BEACH PROFESSIONAL SEMINARS
3555 Ponds Wood Drive
Chesapeake Beach, MD 20732 – Sonia Hinds, Director
410-535-4942 * cbps2006@yahoo.com * www.cbpseminars.org

PLAY THERAPY TRAINING QUESTIONNAIRE – 3/9/09
In order to provide the training you need, please complete this questionnaire and return to us by saving in a separate file and sending it via e-mail ASAP. Thank you for your participation.

Name_________________________________Degree______________Title_______________

Home address ___________________________City___________________State______ Zip Code____

Home Tel.#______________________________Employer________________________

Cell #___________________________________

1. I provide mental health services to children ages:_________. I provide services to adults only: Yes___ No___

2. My title is:_____________________________________

3. I have never had play therapy training: Yes___ No___

4. I have attended more than three play therapy workshops: Yes___ No___

5. I feel confident with the play therapy training I have had: Yes___ No___

6. I need more play therapy training: Yes___ No___

7. I am aware that I can become a Registered Play Therapist through the Association for Play Therapy in Fresno, CA with 150 hours of training and supervision: Yes___ No___

8. Fridays are good days for training: Yes___ No___. If no, please indicate which day of the week would work for you.

9. I am aware of the 2 for 1 Buddy Registration opportunity: Yes___ No___.

10. My employer provides funding for training: Yes___ No___.

11. I am willing to fund training for myself even if my employer does not pay for it. Yes___ No___.

12. I am interested in signing up for the following play therapy workshops as listed on the website: www.cbspeminars.org. Please list the topics even if you are not ready to formally register.

13. Please list topics you would like us to consider. _______________________________________.

14. I know at least one clinician I can partner with to take advantage of the 2 for 1 registration fee: Yes___ No___.

Please names and addresses of potential workshop participants:
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________

15. I will support this training and tell others: Yes____ No____

Please note that in keeping with the economic decline, we have drastically reduced the cost of our trainings. Please take advantage of this limited opportunity. Also, please tell your colleagues about our training.

Regular cost: $110 per workshops per day except sandtray. Reduced rate: 2 can register for the cost 1. Find a partner and split the cost of one registration fee.


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