Parent Support Group Registration Form

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Christian Hill, LPC

5850 Town and Country Blvd.
STE 801, Frisco, TX 75034
719-233-8336
www.christianhillcounseling.com
christianhillcounseling@gmail.com
TX License: #8666

The parent support group is a small support group of parents, intended for one or both parents, who are looking for more support in raising their teen or adult children. Each group meets weekly and is led by Christian Hill, LLC. This group provides parents with a safe place to connect, process, receive more support, and walk away with practical tools both from Christian and other parents in the group.

WHO: Any parent(s) looking for support in raising their children in today's challenging teen culture.

WHAT: Weekly parent support group. Virtual and in-person groups available

WHEN: TBD by the group

WHERE: 8668 John Hickman Pkwy Suite 801, Frisco, TX 75034. Or weekly virtual event with link.

HOW MUCH: $50 per session

MORE INFO: Contact Christian at 719-233-8336 (call/text), or email christianhillcounseling@gmail.com

Email *

How did you hear about Christian Hill and the Parent Support Groups?

I/we are interested in:
*

The in-person meeting at Frisco office location

The virtual parent support groups

I/we open to either

Parent(s) name(s) *

Will one or both parents be attending?
*

Just me

Me and my spouse/partner

Unsure yet

What is your relationship to your child?
*

Contact phone number to text for group times and updates
*

Age of child you are wanting more support with?
*

Please list and share your parenting concerns and any specific goals you have for group
*

Please select each option verifying you understand and agree on these terms to be in group
*

Yes, I/we understand that the parent support group is not counseling and therefore should be considered a substitute for therapy.

I/we consent to participation in the parent support group and agree to the terms of participation and payment.

I/we understand if we commit to a group therapy session that we are obligated to pay the full amount even if we do not attend.

I/we understand and agree to each group member's privacy and confidentiality is necessary and therefore will keep all content and information shared in group to be strictly held as private and confidential within the group.

Required

Today's date
*

YYYY

By typing my name below, I understand and agree that this form of electronic signature has the same legal representation and effect as my personal written signature.
*

I agree to the terms above. *

Yes

Required

Christian T. Hill Signature

A copy of your responses will be emailed to the address you provided.

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