Confident Families

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Confident Families

"We may not be able to prepare the future for our children, but we can prepare our children for the future."

Email *

Your Name *

Phone *

Email *

Child's Name *

Birthdate *

YYYY

School/Grade *

Which statement best describes you? *

You're concerned about grades. You notice the procrastination on getting school projects, papers, and homework done or the lace of focus, or the overwhelm. And the grades are not where you think they should be — where they could be.

You are worried about your kids’ safety. That they’ll fall in with the wrong crowd. You hear stories of bullying, health scares, abductions, and worse. You want to keep your child safe while fostering a sense of independence - but it just doesn’t seem possible.

All of the above.

Other:

What is causing you to reach out to me now? *

What's one result that you'd like to see? *

Is there anything else you'd like to share with me? *

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Fit From Within. Report Abuse

Forms