PREPARE TO PREVENT PROGRAM APPLICATIONIn order to be considered, please fill out this form to make sure we're a good match for the coaching program. MY goal is to help you and your child prepare for their next step of entering a new school or ANY child care environment being well equipped and skilled at boundary setting & safety practices!Please enable JavaScript in your browser to complete this form.Name *FirstLastEmail *What is the age(s) of your child(ren)? [Check All That Apply] *3 Years Old4 Years Old5 Years Old6 Years OldWhat Abuse Prevention Education Have You Taught Them So Far? *Correct Names of Private PartsSafe Vs Unsafe TouchConcept of Tricky PeopleBoundary SettingTalking To Relatives About Abuse PreventionSecrets SafetyWhich of these have you signed up for with me before? *Getting Started With Abuse Prevention WorkshopSecrets Safety MasterclassChild Predator Protection Masterclass (About Grooming)CONSENTletters™ TemplatesPrivate Parts Safety 3-Part Workshop5 Day Kindergarten IntensiveNoneHow many children do you have? *What are your family dynamics? *Partnered [Your spouse/partner live with you and your children]Blended [Your spouse/partner live with you and your biological child(ren)]Blended + [Your spouse/partner live with you and have bonus child(ren), and currently none of your own]Blended + [Your spouse/partner live with you and have bonus children and your own biological child(ren)]Co-Parenting, Not PartneredSingle ParentingOtherWhat is your biggest challenge in teaching your kid(s) about abuse prevention/safety? *What is your biggest hope or goal in signing up for this coaching program? *Are you a survivor/thriver? [Check all that apply] *Yes, CSA (child sexual abuse)Yes, sexual assault/rape in youthYes, sexual assault in adulthoodNo, have never experiencePrefer not to answer this.Yes, have experienced sexual assault/abuse but consider myself a thriverWill you be able to attend the live coaching sessions? *YesWill do my bestNot sure, but will watch replaysWhat are your preferred times for live coaching on Sundays? *12pm/est4pm/est7pm/estPlease note that we will likely have a variation of all three time options depending on the demographics of locations from around the world.What is your day for 'Office Hours'? *ThursdayFridaySaturdayWhat country are you in? *CanadaUnited StatesUnited KingdomAustraliaOther (if other, please add it in the section below)If you selected 'Other' for country, please list what county you're in below.Is there anything else you'd like to share or ask? *Are you interested in meeting 1:1 before joining the program to see if it's a good fit for you? *Yes, please!No thanks, I know your work and am ready to join!Maybe, depends on time.Submit
