Helping Parent One on One Match Request
A Helping Parent match can provide personal support from a trained volunteer Helping Parent mentor who has a child with similar needs.  They can be helpful  in coping with challenging experiences & feelings.

After you submit this form, we will contact you by phone or email to talk about your Helping Parent Match. Please submit a separate form for each child you would like to have Helping Parent support with.

Christie Chiles - Grays Harbor Parent to Parent Coordinator
Amber Cook - Pacific County Parent to Parent Coordinator

Questions? 360-537-7000 or info@arcgh.org
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Email *
Parent First Name *
Parent Last Name *
Parent Birth Date *
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Phone Number *
Text Messages Ok? *
Address Line 1 *
Address Line 2 (optional)
City *
State *
Zip *
Parent's Race (Select all that apply) *
Required
Parent's Ethnicity *
County you Reside in *
Child's Name *
Child's Birthdate *
MM
/
DD
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Child's Race (Select all that apply) *
Required
Child's Ethnicity *
School District you live in *
School (if any) your child attends *
Please select from the following in regards to your child: *
Required
Diagnosis of Child *
Concerns regarding your child *
What do you hope to gain by being matched with a Helping Parent? *
Please check ALL that apply, I'd like to: *
Required
How did you hear about us?
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