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Child Parent Relationship Training Interest Form
Thank you for your interest in CPRT! Please fill out the form below, and we will contact you shortly to schedule a 30 minute phone or video session to discuss CPRT in more detail.
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Name
*
Your answer
Best Contact Phone Number
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Your answer
Email Address
*
Your answer
Emergency Contact Person & Phone Number (needed for group enrollment)
*
Your answer
Anticipated number of group participants (couples welcome!)
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1
2
Other:
How did you hear about this group?
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Your answer
Are you looking for counseling services?
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Your answer
Are there any safety concerns for your child or family?
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Your answer
In thinking of the child you struggle with the most, what is your biggest concern?
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Your answer
How do you hope CPRT will help? What are your goals?
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Your answer
What are best days/times for a 20-30min call? We look forward to speaking with you soon!
*
Your answer
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