|
If you would like to enroll your child into the Teen Straight Path program, please answer the questionaire and form below. We will then get in contact with you.
|
|
Does your teen lack self-esteen and self worth?
|
Yes
No
|
| |
|
Does your teen display patience and concentration while watching a movie?
|
Yes
No
|
| |
|
Does your teen have the ability to listen to others and to work well as apart of a team?
|
Yes
No
|
| |
|
Does your teen display a high-level of self-motivation, commitment, and dedication?
|
Yes
No
|
| |
|
Do you worry your teen may not finish high school?
|
Yes
No
|
| |
|
Does your teen display organizational and time management skills at home or at school?
|
Yes
No
|
| |
|
Does your teen seem unmotivated or depressed
|
Yes
No
|
| |
|
Does your teen display the ability to work under pressure and to meet deadlines?
|
Yes
No
|
| |
|
Do you worry about your teens future?
|
Yes
No
|
| |
|
To your knowledge, has your teen ever tried drugs?
|
Yes
No
|
| |
|
To your knowledge, has your teen ever consumed alcohol?
|
Yes
No
|
| |
|
To your knowledge, has your teen ever cut themselves?
|
Yes
No
|
| |
|
Has your teen ever talked about committing suicide?
|
Yes
No
|
| |
|
Has your teen ever tried to commit suicide?
|
Yes
No
|
| |
|
Does your teen take good personal care of themself?
|
Yes
No
|
|
|
Please fill out full name, address, date of birth, and legal parenting status.
|
| |
|
Name (Last, First, Middle Initial)
|
|
|
| |
I am the:
Parent
Legal Guardian
|
| |
|
Child's Name (Last, First, Middle Initial)
|
|
|
|
|
Address
|
|
| |
|
|
| |
|
Email Address
|
|
|
|
|
How did you hear about us?
|
|
|
|
|
By checking this box you are acknowleding the submission of this application to apply your teen for the Straight Path program from Living Free
|
|
Please Enter This Verification Number:
|
