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Whether you are new to Positive Discipline, or have been using the techniques for years, here is your chance to help give something back. There are many amazing and well qualified Positive Discipline Parent Educators out there working very hard to teach many parents, teachers, grandparents, foster and step-parents, babysitters, nannies and much more, the power of Positive Discipline. However, these wonderful Parent Educators often find it difficult to find suitable locations to teach. Whether the cost to rent a room in a hotel is just too expensive, or there is not enough space, they often find that because of a simple, but solvable problem, we are limiting the potential of getting Positive Discipline through to so many more.

Because of this, we have created the first ever “Become a HOST” system where you can donate your home or office space for free, or choose to charge for space, and you will become an important part in helping to spread Positive Discipline to as many folks as possible.

As a HOST you can receive many benefits such as FREE workshops for you and your family, and even make some additional income by providing the space. Whether you are willing to donate space within your home or business, the benefits will far outlast any work you put into this system. Finally, being a HOST, you are under no obligation to continue to provide space, and can ask to be removed from this program at any time.

Please take a moment to fill out the information below and one of our associates will contact you soon to discuss including you in the HOST system:

Your Name	First:   Last:
Is this location a personal residence or a business?	Personal Business
Name of business (if location is a business and not a residential location)
Type of Business
Address of HOST Location (this will be the address of where you will offer the space for a workshop)	Street:   City: State:   Zip:
Phone
Email
Is this location large enough to accommodate up to 30 people?	Yes No
If not, what is the maximum?
Are you going to donate your space, or charge for your location?	Charge Donate
If you will charge a fee for your location, what is the per hour rate? $
Are you willing to host an 8 week workshop, a 1 day, or both?	8 Week One Day Both
Are you familiar with Positive Discipline?	Yes No
Do you have the proper liability insurance for this location? (If a residence, homeowner’s policy, or if a business, general liability.)	Yes No
Policy Number
Name of Insurance Company
Date of Issuance	/ /
Date of Expiration	/ /
By checking this box, I certify the information provided above is true and accurate.