Parent/caregiver focus group sign up sheet
Thanks for your interest in participating in one of our focus groups about caregivers' relationships with their children, and the ways caregivers talk with their kids about substance use, specifically drinking alcohol and using cannabis. Please complete this form to sign up. Once you submit this form, Caroline Johnson, the study coordinator, will reach out to confirm your participation.

Focus groups will take place in-person at the Collaborative for Educational Services (CES) in downtown Northampton (97 Hawley Street). Parents and caregivers of 12-18 year olds who live in Hampshire County are eligible to participate in one of four possible focus groups, which will take place from 6-7:30pm on the following days:

-Tuesday, April 30
-Thursday, May 2
-Tuesday, May 7
-Thursday, May 9

Food and drink will be provided during focus group conversations, and at the end of the discussion, each participant will receive an $80 Visa gift card. Depending on need, we may offer free childcare during the focus groups; if that ends up being the case, we will let you know in advance!
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Name *
Email *
Phone number *
What city or town do you live in? *
Are you a parent or caregiver? *
Required
How old is your child, or children? Please select all that apply. *
Required
How old are you?
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What race(s) and ethnicities do members of your household identify with? Please check all that apply.
We have a few questions about your children, because we want to make sure that we hear from parents and caregivers of diverse youth. Doing so will help make sure that results from these focus groups benefit our entire community, so thank you in advance for sharing this information with us! All information you provide in this sign up form is confidential; no one other than Caroline Johnson, the study coordinator, will have access to it.
Do any of your children have an IEP or 504?
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Do any of your children identify as lesbian, gay, bisexual, or with a sexual identity other than straight?
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Do any of your children identify as trans, nonbinary, gender expansive, or with a gender identity other than cis?
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The last two questions are about your availability to attend one of our focus groups.
What days are you available to participate in one of the focus groups?
First choice
Second choice
Third choice
Unavailable
Tuesday, April 30 (6-7:30pm)
Thursday, May 2 (6-7:30pm)
Tuesday, May 7 (6-7:30pm)
Thursday, May 9 (6-7:30pm)
Would you use free, on-site childcare (at the Collaborative for Educational Services) if we provided it?
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