Active Parenting Registration Form
THANK YOU for registering for our Active Parenting workshops to learn about the importance of raising resilient children and how that happens. Our hope is that you learn new ways or improve on tried and true techniques to improve your family dynamic. You will meet with a licensed therapist weekly for six weeks who will guide you to improved communication, behavioral techniques, and so much more to apply within your household.

The $60 fee can be paid or fee assistance arranged at your first workshop, so please arrive 15 minutes early. All classes will be held at Willowstone Family Services, 615 N. 18th Street, (Howarth Center) Suite 101, Lafayette, In 47904 unless otherwise stated. A free light meal and childcare for potty-trained children ages 3 & up is now available.

If you have questions about this program or need information regarding the fee assistance qualifications, please contact our office at 765-423-5361. You may also email our client services coordinator, Kristi Whitworth-Mitchell, at We look forward to seeing you during your first class session! Don't forget to spread the word and tell your family, friends, and others about this important learning opportunity.
Email address *
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First Name *
Last Name *
Address *
City *
Zip Code *
Phone number *
Do you need our free childcare to attend classes?
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If yes, please list your children's names and ages. (Must be potty-trained, ages 3 and up)
What skills or information do you hope to learn from this parenting program? *
How did you learn about our Active Parenting class? *
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