Halo Program
Thank you for seeking out HALO Program for your family. We are honored that you would trust us to meet your family’s needs. We believe that HALO will help you and your family tremendously.

**Please note, we are only able to provide services for kiddos ages 4-8 at this time.  However, parents of kids that don't fall into that age range may still audit the parent-focused "Trauma Education Classes."

Once you fill out the application below, you will be added to our wait list and should receive a confirmation email and communication from us within 48 hours.  Reach out to anthony@villagetovillageintl.com if you don't receive a response.

In the meantime, here are some quotes from our families:

"The whole program is amazing, and I think everyone should do it.  But if for no other reason, do it for the therapeutic lifebook."

"We walked into this program hoping to find the tools to "fix" our child, but instead are walking away with a deeper understanding that we were the ones that needed to adjust our parenting strategies to connect with them and build a stronger connection to set them up for success."

"Please take this class and learn a new way of approaching parenting! It may be different, but it is so good! This training and therapy changed our lives forever. I cry out of happiness when I think of the difference it has made and will continue to make in our relationship from now on."

"Invest in this kind of training. Our kid loved it and applied it in ways we didn't know he would."

"I have more compassion for myself as a highly stressed parent struggling with my child's behavior. I also see how just an adjustment in my own perception and skills/strategies, and a bit of extra support was all I needed. I wasn't a bad parent, and she wasn't a bad kid. We just needed more help."
Sign in to Google to save your progress. Learn more
Number of Primary Caregivers
Caregiver #1 First and Last Name *
Caregiver #1 Email *
Caregiver #1 Phone Number *
Is it okay to text this number?
Home Address
Caregiver #2 First and Last Name
Caregiver #2 Email
Caregiver #2 Phone Number
Is it okay to text this number?
Clear selection
How did you hear about this program? *
Child's First and Last Name *
Child's Date of Birth *
MM
/
DD
/
YYYY
Child's Age
Child's Sex/Gender *
Child's T-Shirt Size *
Parent #1 T-shirt size
Clear selection
Parent #2 T-shirt size
Clear selection
Type of Insurance (Primary and/or Secondary): *
DCS Worker's Name (If Applicable)
DCS Worker's Number (If Applicable)
Foster Care Agency (If Applicable)
In families with more than one caregiver, are both caregivers and child able to meet in the evening one night a week for 10 weeks from 6:00-8:00?  Caregivers will participate in Trauma Education Classes while the target child participates in Kids' Club. *
Are you able to arrange childcare for your other kiddos (if applicable) while the rest of the family is at Halo night? *
Do you and your child/teen agree to counseling sessions once a week during the day? The sessions will likely be held between the hours of 8:15 am and 3:00 pm. The day of the week varies. In families with multiple caregivers, both caregivers will be asked to participate as much as possible.
 *
If your child is in foster care, are they likely to be unified with their biological parents before the completion of the project?
 *
Caregivers, please be aware that your name will be on the Halo Program waitlist which is monitored by more than one member of the Village To Village staff. Is this ok?
 *
Is the child/teen receiving counseling services at another agency?
 *
What other services have you participated in?
Explain why you think Halo Program would be helpful for you and your family.
If you attend church regularly, which church do you attend?
We will provide snacks for Kids Club.  Does your child have any allergies?
Is there anything else you would like us to know?
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Google Forms