Emotional Regulation Skills Class Interest Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Help us gauge interest for classes teaching emotional regulation skills in your local area and find potential instructors.

Email *

Full Name *

Which best describes your interest in Emotional Regulation Skills classes?

Interested in enrolling a child/children

Interested in becoming a class instructor

Both enrolling a child and becoming an instructor

Clear selection

What is the primary ZIP Code or area where you would like these classes to be offered?

Which age groups of children are you interested in class offerings for?

Preschool (Ages 3-5)

Early Elementary (Ages 6-8)

Late Elementary (Ages 9-11)

Middle School (Ages 12-14)

High School (Ages 15-18)

What specific emotional regulation skills are you most interested in having covered in the classes? (Select all that apply)

Identifying and naming emotions

Coping strategies for big feelings (e.g., anger, anxiety)

Impulse control and frustration tolerance

Mindfulness and relaxation techniques

Problem-solving and conflict resolution

Building resilience and self-esteem

How would you rate your current knowledge of emotional regulation techniques?

Very Limited Knowledge

Expert Knowledge

Clear selection

If you are interested in becoming an instructor, please describe any relevant experience or qualifications you have (e.g., education, childcare, teaching, therapy).

What is your availability like for instructing classes (e.g., weekdays, evenings, weekends)?

Weekday Mornings (9am - 12pm)

Weekday Afternoons (1pm - 4pm)

Weekday Evenings (5pm - 8pm)

Saturdays

Sundays

What is the best way to contact you regarding class updates or instructor opportunities?

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Calm & Colorful.

Does this form look suspicious? Report

Forms