2. First Name of Parent or Guardian*
3. Last Name of Parent or Guardian*
5. Address
7. City*
8. State*
9. Zip*
11. Email Address*
12. Phone number*
14. Name(s) of person(s) attending this group.*
16. Name of school(s) children attend and their grade level(s).*
18. Number of family members living in your residence.*
19. Which of the following best describes you?*
    -- Select One --Asian or Pacific IslanderBlack or African AmericanHispanic or LatinoNative American or Alaskan NativeWhite or CaucasianMultiracial or BiracialA race or Ethnicity not listed

    Please select one answer

21. Which group are you interested in?*

    1. ADHD
    2. Active Parenting
    3. Calm Confident Kids
    4. Divorce Separation
    5. Dream It Be It
    6. Girls Count!
    7. LGBTQ+ Empowerment
    8. LifeSkills for Young Adults

    Please Check all that apply

22. How did you hear about this group?*

    1. Bowie Youth & Family Services/Bowie City Website
    2. Friend or family
    3. School
    4. Bowie Spotlight
    5. Other

    Please Check all that apply

24. Have you or your family members participated in a group counseling program of any kind before?*
26. If yes, please list program(s):
Leave This Blank:


28. 1. Receive an email copy of this form.
29. Email address

    This field is not part of the form submission.

30. Submit

* indicates a required field