Teens & Tweens Registration

The Toolbox for Teens & Tweens

Congratulations! We are going to embark on a rewarding journey together. Below you will find a series of questions that will enable us to tailor this adventure just for you - whether the current challenge is communication, conflict, trust or discipline we will create the best step by step plan to meet your needs.

* Indicates required field

Name (what do you want me to call you?) *

Email *

Marital Status *

What is your occupation? *

What are your children's names and ages? *

Do they live with you full time? *

Yes No

Are your children on any medication? *

Yes No

If so, what is the med and diagnosis? *

What is the biggest challenge right now? *

If you could magically change the situation, how would it be better? *

What is getting in your way? *

What do you do in your spare time? *

Besides your relationship with your kid(s), what is the next area of stress in your life? *

Submit