CARES D.A.D.S interest form

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* 1. Name

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* 2. Phone

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* 3. Email

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* 4. Home address

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* 5. Are you a parent?

Yes

No

Other (please specify)

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* 6. How would you rate your comfort interacting with high school students?

Very comfortable

Mostly comfortable

I have some discomfort interacting with high school students

I have trouble communicating with high school students

Other (please specify)

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* 7. To participate in this, you need to be available any day of the week, 11:00 am - 1 pm or 2:30 - 3:30 pm.

Yes

No