Purposeful Parenting Video
The Purposeful Parenting Video is 31 minutes of information hosted by Candace Couch, LPC about effective communication with kids & teenagers. When you register, you will get access to the video as well as the Purposeful Parenting "flashcards" that will be mailed the address you enter below.

Please complete this form as well as pay the registration fee of $15. An invoice for payment will be sent to your email inbox.
The link to the video will be emailed to you when registration is complete.
The Parenting Prompt Cards provided with the video will be mailed to the address you provide on this form.
Sign in to Google to save your progress. Learn more
Email *
First Name *
Last Name *
Email Address *
Ages of Children *
Street Number and Name *
City & State *
Zip Code *
This is a consent form to provide you with information about this parenting video so you can make an informed decision about participating. The purpose of this educational video is to provide skills that are often helpful to facilitate healthy communication and relationships between parents and their children during childhood and adolescence. This is not counseling or a counseling group. While Candace Couch is a licensed counselor, this is not a counseling service. Please understand that counseling services are not being provided for you or your family during this video. This is an informational and skill building opportunity.  If you agree to having access to this video, please know that is is content created for those who have paid to view it. Please do not forward the link to others. Hopefully, you will leave more informed (with insight and skills) about parenting. The only known risks associated with these educational materials is the possible disagreement with the opinions of  the presenter and possible emotional distress concerning yourself and your family’s situation as you gain insight and see areas for growth and change.   By signing this form (typing my name and clicking "I agree") I am agreeing to voluntarily participate in this educational opportunity and to not forward this information on to others who have not purchased it. I have had a chance to read this consent form and/or it was explained to me in a way that I understand. I have had the opportunity to ask questions and have received satisfactory answers. I understand that I can withdraw at any time. A copy of this signed Informed Consent Form is available for me upon my request to Candace Couch. *
Type name here to consent: *
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Candace Couch Counseling. Report Abuse
Google Forms