Youth Counseling Ministry Registration Form

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Sessions are for MIDDLE school students ONLY who are members of Love & Faith. Sessions will begin Thursday April 6th-Thursday May 4th at 6:30 pm via Zoom. Please complete the form below and we will be in touch soon!

Are you a LFCF Member? (Only available to LFCF Members) *

Yes

Parent/Caregiver's First & Last Names *

Child's First & Last Name (if more than one child, please provide names for each child) *

How many children would you like to register? *

Please select the age(s) for your child(ren) *

Other:

Required

My child needs help with the following topics(s)...please select all that apply *

Anger

Anxiety

Low Self-Esteem

Rebellion

Grief

Other:

Required

Parent's preferred phone number *

Parent's preferred e-mail *

Child's Email Address *

Parent's Preferred Contact Method *

Phone

Questions and comments

Submit

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