CPRT Group Interest Form
Please fill out this form to indicate your interest in joining the Child-Parent Relationship Therapy (CPRT) Group at Renewed Counseling & Play Therapy. Each group runs for 8-10 weeks, and meets on Sundays from 6-8 pm. We have groups every Fall and Spring. Our next group starts in February of 2026.

Completion of this form does not commit you to the group, but rather communicates your desire to learn more and consider if it might be a good fit for you and your concerns. I will reach out to you to answer questions and provide next steps should you choose to move forward with the group. Please email amywork@renewedcounseling.net with questions.
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Parent/Guardian 1 Name *
Parent/Guardian 1 E-mail Address *
Parent/Guardian 1 Phone Number *
Parent/Guardian 2 Name
Parent/Guardian 2 E-mail
Parent/Guardian 2 Phone Number
Child's Name *
Child's Birthday *
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What are you hoping your participation in a CPRT group will help with? What changes do you hope to see in your family as a result? *
How did you hear about this group? *
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