Mindfulness-Enhanced Strengthening Families Program 10-14 (MSFP 10-14) Registration Form
The Mindfulness-Enhanced Strengthening Families program 10-14 is for youth ages 10-14 and their parents or caregivers. Register now to save your spot!  

We want to welcome you to a great class!  Here are the details about the class.
• Class starts Thursday, October 8th and ends November 19th (seven classes)
• Times: 4:00pm - 5:15pm Youth
               6:00pm - 7:15pm Parent Session
               7:15pm - 8:15pm Family Session
• Classes will be held via Zoom Meeting. You will need an internet connection with either broadband wired or wireless (3G or 4G/LTE), speakers and a microphone either built-in or USB plug-in or wireless Bluetooth, and a webcam or HD webcam either built-in or USB plug-in, or a Smartphone with Zoom Meeting Application.  We will connect with you to provide instructions for testing your equipment once registration is submitted. Registration is open until September 28, 2020.  As a registered participant we expect you to attend all 7 sessions & complete assigned activities with your youth between classes.  (If you are unable to attend a session, please contact one of the educators.)  Contact Kim Kies with any general questions at: Kim.Kies@wisc.edu.  
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List the parents/caregivers who will be attending MSFP
Parent/Caregiver Name 1: *
Parent/Caregiver Name 2:
Address: *
City: *
County: *
Required
ZIP: *
Parent / Caregiver 1 telephone including area code: *
Parent / Caregiver 2 telephone including area code: *
Can we text you on your cell phone?
Yes
No
Parent/Caregiver 1
Parent/Caregiver 2
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Parent / Caregiver 1 Email
Parent / Caregiver 2 Email
List youth (ages 10-14) who will be participating in MSFP
Youth 1 Name (age 10-14) *
Youth 1 Age *
Youth 2 Name (age 10-14)
Youth 2 Age
Youth 3 Name (age 10-14)
Youth 3 Age
Please share any diet restrictions or food allergies (in case food is involved in any sessions)
How did you hear about this program?  
Write any other information you would like us to know or questions you have before coming to the program.
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