This registration form is required in order to sign-up for the Guiding Good Choices program. The pre-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. 

Question Title

* 1. What is your first and last name?

Question Title

* 2. What is your date of birth?

Question Title

* 3. What is your address with city, state, and zip code?

Question Title

* 4. What is your gender?

Question Title

* 5. What is your race or ethnicity?

Question Title

* 6. Are you of Spanish, Hispanic or Latino origin or descent?

Question Title

* 7. At what email address would you like to be contacted?

Question Title

* 8. At what phone number would you like to be contacted?

Question Title

* 9. Will you need childcare for youth ages 8 and younger in order for you to attend this program?

Question Title

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

Question Title

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

Question Title

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

Question Title

* 13. When you are angry with your child its best to tell him/her immediately.

Question Title

* 14. Yelling at your children when you are angry with them gets the best results.

Question Title

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

Question Title

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

Question Title

* 17. I often tell my child how I feel when he or she misbehaves.

Question Title

* 18. When my child tells me something important, I let him/her know that I am trying to understand what he/she is feeling.

Question Title

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

Question Title

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

Question Title

* 21. Does your child help with family fun activities?

Question Title

* 22. Does your child like to get involved in such family activities?

Question Title

* 23. Do you have time to listen to your child when he/she wants to talk to you?

Question Title

* 24. Do you and your child do things together at home?

Question Title

* 25. Does your child go out with other family members to movies, sports events, or other things?

Question Title

* 26. Do you have friendly chats with your child?

Question Title

* 27. Does your child help with chores, errands, and/or other work?

Question Title

* 28. Do you talk with your child about how he/she is doing in school?

0 of 28 answered
 

T