What are the age(s) of the child/children in your care? *
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What is your relationship to the child/children that brings you to the program? For example, mother, aunt, grandparent, etc. *
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The program is intended for participants to attend all 5 sessions. Do you plan to attend all sessions from 6:00-8:00pm (Oct 4, 11, 18, 25, and Nov 1) in person? *
How did you hear about the program?
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How would you describe your preteen or teen? For example, "she/he is outgoing and involved in school."
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How would you describe your relationship? For example, "we have a good relationship overall but we rarely talk and our house is chaotic!"
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What do you hope to gain from the program? What concerns do you have about raising your teen?