"Active Parenting of Teens and Pre-Teens" Workshop Interest and Screening Form
Thank you for inquiring about the Active Parenting of Teens workshop at Legacy Counseling Services, PLLC. This workshop is intended for parents of pre-teens and teens who want to enhance their relationship with their teen, learn how to encourage their teen in a world full of negative influences and discouragement, and achieve cooperation and mutual respect. Please complete the form if you are interested in being considered for the workshop. Space is limited. This information will be kept private and confidential as it is virtually stored in our HIPAA compliant email system through Google Workspace.

The workshops will take place over the course of 2 days for 3 hours each day (3:00-6:00 pm). Workshop dates in 2022 are as follows: Workshop #2: April 17th and 24th, Workshop #3: July 17th and 24th, and Workshop #4: October 23rd and 30th.

In each session, we will discuss a new topic that impacts how you communicate with, relate to, and discipline your teenager.  The sessions incorporate video presentation, teaching from a professional, practice using workbooks, and group discussion.

Any parent of pre-teens or teens is welcome to attend this skills-based workshop, as the topics covered apply to all families. While this workshop is not intended to be a replacement for therapy, it is highly recommended for parents whose child is in therapy. Some of the topics covered include:

- Teen development
- Achieving mutual respect
- Communication skills and communication blocks
- Discipline methods
- Building courage and self-esteem
- Handling power struggles
- Reducing the risks of drugs, sexuality, and violence

This investment in your family for the 2-day workshop is a total of $325.00 (this price includes the $25.00 cost of the required parent workbook). This investment equals $50 per hour for each session. Each day of the workshop must be paid in full at the beginning of each day (e.g., $150 for Jan 23; $150 for Jan 30).

The cost of the class includes you and a support person (spouse, co-parent, friend, etc.). It is both optional and free to bring one support person to each session.

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Email *
I would like to enroll for the workshop on the following dates: *
Required
How did you learn about this workshop? *
Your first and last name. *
Your date of birth (month/date/age) and your age. *
Your phone number where we may contact you *
May we leave a voicemail message at the phone number above? *
What is/are the age(s) of your child(ren)? *
What current difficulties or issues are you currently facing with your pre-teen or teen? *
What would you like to get out of this workshop? *
Are you planning on bringing a support person (i.e. your spouse, a co-parent, friend, family member, etc.)? *
How comfortable are you in talking about your thoughts/feelings/experiences regarding parenting? *
Not at all comfortable - I never talk about it.
Very comfortable - I am awesome at this.
Where do you see yourself having the most trouble as we talk about parenting skills, and your relationship with your child(ren)?
Does your preteen/teen currently see a therapist? *
Have you had a suicide attempt in the past 3 months? *
Has your pre-teen/teen had a suicide attempt in the past 3 months? *
Have you had serious thoughts of killing yourself in the past 3 months such that you have been rehearsing a plan regularly? *
Has your preteen/teen had serious thoughts of killing him/herself in the past 3 months such that her/she has been rehearsing a plan regularly? *
Have you been hospitalized for psychiatric reasons in the past 3 months? *
Has your teen been hospitalized for psychiatric reasons in the past 3 months? *
**If you have had thoughts that you would be better off dead or of hurting yourself or others in some way, please go to a hospital emergency room, call 911, or call the Tulsa COPES Hotline at 918-744-4800 *
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