Parent Interest Form
First Name
Last Name
Email
Phone
State
Teens Name
What are some of your Teens Attributes and Challenges?
What are goals for yourself and for your Teen?
What is the PAY OFF for achieving these goals? How is your life going to be different for both you and your son or daughter?
Are you committed to work alongside Addie and Claudia to hold yourself or your teen accountable with the strategies they give you both?
Yes
No
Maybe
How did you hear about us?
Whats your Facebook Name?
Submit