Parent Support Group Intake Form
Parents of children ages 0 - 12 months are invited to join our New Parent Support Group facilitated by our very own Katie Kaufman, LCSW. Bring your little one and find support and community to parents struggling with the immense challenges that come with having young children. You'll leave with tools to get through the day, and a support network you can rely on in difficult moments.

Dates of Sessions:
March 12, 19, 26
April 2 
Sign in to Google to save your progress. Learn more
Your name *
Email address *
Cell Phone Number (not required, but extremely helpful!)
Please describe the family structure of your household, including the name(s) of partners and age(s) of your child(ren). *
What do you expect to get out of a support group like this? *
Are there any topics in particular that you would want to focus on in this group? *
Is there anything else that we should know about your family that would be helpful for us to know in supporting you? *
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Temple Beth Elohim. Report Abuse
Google Forms