I'm interested in participating in PEPS Parents of Adolescents and Teens (PAT) program
 
 
 
 
First Name*
 
 
 
 
Last Name*
 
 
 
 
Email*
 
 
 
 
 
 
 
Please specify the age(s) of your child(ren):
 
 
 
 
10-12
 
 
 
 
13-15
 
 
 
 
16-19
 
 
 
 
 
 
 
Please indicate your availability for meeting times:
 
 
 
 
Weekdays - before 5 PM
 
 
 
Weekdays - after 5 PM
 
 
 
Weekends - Morning (before 12 PM)
 
 
 
Weekends - Afternoon (12-4 PM)
 
 
 
Weekends - Evening (4 PM or later)
 
 
 
No preference on meeting time - will make it work!
 
 
 
 
 
 
Questions and Comments
 
 
 
 
 
 
Submitting this form authorizes PEPS to send information and updates on our program for adolescents & teens and confirms your interest in participating.