Parenting an Adolescent or Teen? Interested in finding connection, resources, and community? Need support in specific topics around adolescent parenting? Please provide more information below so we can offer program options to best suit your needs.
 
 
 
I'm interested in participating in PEPS Parents of Adolescents and Teens (PAT) program
 
 
 
First Name*
 
 
 
 
Last Name*
 
 
 
 
Email*
 
 
 
Zip*
 
 
 
 
Name of your Middle School or High School*
 
 
 
 
 
Please specify the school grade(s) of your child(ren):
 
 
 
 
Child(ren) Grade in School
 
 
 
 
 
 
Please indicate the discussion topics that are most relevant for you as the parent of an adolescent
 
 
 
PAT Topics - Please select your top 4 choices
 
 
 
 
 
Please indicate the group type that would be most relevant to you for joining the PAT Program
 
 
 
PAT Group Choice*
 
 
 
 
 
Please indicate the group format that you would prefer for joining the PAT Program
 
 
 
 
PAT Group Format
 
 
 
 
 
 
 
Please indicate the timeframes that you would consider for joining a PAT Group
 
 
 
PAT Group Timeframe Selection*
 
 
 
 
 
Please indicate your availability for meeting times:
 
 
 
 
PAT Group Meeting Time Selection
 
 
 
 
 
Questions, Concerns and Comments
 
 
 
 
 
 
I would like to remain connected and join/support this program in the following ways
 
 
 
PAT Connection choice
 
 
 
 
I have a friend who would like to receive information about the PEPS Parents of Adolescents and Teens (PAT) Program
 
 
 
Friend's Email
 
 
 
 
 
 
Submitting this form authorizes PEPS to send information and updates on our Program for Parents of Adolescents & Teens and confirms your interest in participating.