I confirm that my child is between 14 and 17 years old and has been referred for counseling by a school counselor or administrator!

By law, your child is not old enough to enter into a legal contract. You have given your (parent/guardian) consent to have your child work with one of our counselors when you checked the "I Accept" box on the previous page.

You will be responsible for all financial obligations concerning your child's participation in the Choose 2 Change program. There is a one-time nonrefundable registration fee of $125.00 and a $75/session fee. The number of sessions in each program varies. To the left is a list of the programs from which your child's counselor will select based on the assessment the counselor will conduct over the telephone with your child. The number of sessions per program is included in parentheses (). The assessment is included in the registration fee.

To continue the registration process, please select you method of payment for the Registration Fee.

Payment Options:

By Mail:

Send check or money order to:

Choose 2 Change
8855 Morninglight Circle
Riverside, CA 92508

Online via PayPal:
To make your $125 payment through Paypal, click on the PayPal button below.