Parent Teen Community Connection (PTCC) Intake

Please complete this form so Families of the Treasure Coast can help determine whether Parent Teen Community Connection (PTCC) is a good fit for your family. PTCC helps parents, caregivers, and young people build stronger communication, trust, mutual respect, and connection.

Your Information

First Name *

Last Name *

Email *

Phone *

Postal Code *

About Your Family

Child 1 Name *

Child 1 Age *

Child 2 Name

Child 2 Age

Child 3 Name

Child 3 Age

What would you most like help with? *

Program Preferences

Preferred Program Format

How You Found Us

How did you hear about PTCC?

Referring Agency