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Pierce County Juvenile Court Parent Support Programs
Please select which 'Parent Support Program' you would like to register for:
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Families Supporting Families
NAMI-Family to Family
Participant Information
Today's Date:
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First Name:
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Last Name:
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Race:
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Native American
Asian/Pacific Islander
African American
Caucasian
Unknown
Ethnicity:
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Hispanic
Non-Hispanic
Unknown
Gender:
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Female
Male
Unknown
Age:
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Do you speak English?
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Yes
No
Preferred Language:
Address:
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City:
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Zip Code:
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Phone Type:
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Cell
Home
Work
Phone#:
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Email Address:
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Preferred Method of Contact: (Select All That Apply)
Phone
Text
Email
Mail
What Are You Most Looking Forward to When You Join? (Select All That Apply)
Access to resources.
An opportunity to share and be heard in a safe space.
Connect with other parents/guardians with similar experiences.
Increase coping skills.
Learn more about the Juvenile Court process and programs.
Learn strategic tips.
Reduce stress.
Dietary needs (food will be provided):
Vegetarian
Vegan
Gluten Free
Dairy Free
Nut Allergy
Other:
Other:
Please list anyone else who will be attending with you:
Family Member/Loved One Information
Family Member/Loved One is:
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Adult
Youth
Relationship to Family Member/Loved One:
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Parent
Step-Parent
Guardian/Caregiver
Other Family Member
Spouse
Grandparent
Race:
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Native American
Asian/Pacific Islander
African American
Caucasian
Unknown
Ethnicity:
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Hispanic
Non-Hispanic
Unknown
Gender:
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Female
Male
Unknown
Age:
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Do you have a child who is currently involved with Pierce County Juvenile Court?
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Yes
No
Do you have a child who has in the past been involved with Pierce County Juvenile Court?
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Yes
No
Referred By:
I would like to receive an email copy of this registration form:
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Yes
No
Email: (This field is not part of the form submission)
* indicates a required field