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This registration form is required in order to sign-up for the Parenting Wisely program. The pre and post survey is also a requirement for the program. Please fill them out to the best of your abilities. The information on the registration form will not be shared and will be safely stored and used for grant reporting purposes only.

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* 1. Todays date

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* 2. What is your first and last name?

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* 3. What is your date of birth?

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* 4. What is your contact information?

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* 5. What is your race?

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* 6. I have clear and specific rules about my child's association with peers who use alcohol.

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* 7. I have explained my rules concerning alcohol use to my child.

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* 8. I have explained the consequences of not following my rules concerning alcohol use to my child.

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* 9. I have discussed my child goals and dreams with them on several occasions

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* 10. I often tell my child how I feel if he/she has misbehaved

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* 11. When my child tells me something important, I let him/her know that i am trying to understand how him/her is feeling

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* 12. I let my child know I care about him/her while setting limits and consequences.

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* 13. I have discussed our family values with my child on several occasions.

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* 14. Parents should identify positive consequences for following the rules as well as negative consequences for breaking the rules

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* 15. Family meetings to make decisions and rules are a waste of time

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* 16. It is important for family members to practice anger management skills even if it makes them uncomfortable at first

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* 17. When you are angry at your child it is best to tell him/her immediately 

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* 18. Yelling at your children when you are angry with them will get the best results

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* 19. If you learned that your child/children had BROKEN an important family rule, how likely is it that you would: Take away some of their freedom?

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* 20. If you learned that your child/children had BROKEN an important family rule, how likely is it that you would: Tell them how you feel about their breaking the rule?

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* 21. If you learned that your child/children had BROKEN an important family rule, how likely is it that you would: Call them names?

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* 22. If you learned that your child/children had BROKEN an important family rule, how likely is it that you would: Give them added responsibilities?

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* 23. If you learned that your child/children had BROKEN an important family rule, how likely is it that you would: Use physical discipline?

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* 24. If you learned that your child/children had regularly FOLLOWED an important family rule, how likely is it that you would: Verbally praise them?

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* 25. If you learned that your child/children had regularly FOLLOWED an important family rule, how likely is it that you would: Reward them with money or objects?

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* 26. If you learned that your child/children had regularly FOLLOWED an important family rule, how likely is it that you would: Give them more privileges?

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* 27. Do you have any feedback or input for the facilitators?

0 of 27 answered
 

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