Empowering Youth Today- Parent Program Registration

Registration

Please fill out the form to be registered for the EYT Parent Program. If you indicate you would like to participate virtually, a link will be sent to you by the email you provided.

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* 1. First and Last name

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* 2. Email address

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* 3. Telephone/Cell #

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* 4. County of residence

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* 5. I am or represent

Parent/caregiver

foster care parent

aunt/uncle/grandparent

Community member

Educator

Health Services

Other (please specify)

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* 6. I am interested in attending the parent program IN-PERSON

Yes

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* 7. I am interested in attending the event VIRTUALLY

Yes

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* 8. Has your child participated in the Empowering Youth Today Program? (Formerly Michigan Abstinence Program)- This class would occur in a 6th-9th grade health class

Yes