Interest list for caregiving parents | New Song Counseling and Trauma Recovery

Name *

Email address *

Are you the parent or guardian of a child with medical and/or special needs? *

Yes
No

What age is your child? *

0-5
6-10
11-17
18+

What type of support are you hoping for? *

Sharing with other parents
Coping skills
Emotional support
Guidance

Best time for group *

Early morning 7am-9am
Mid morning 10am-12pm
Afternoon 12pm-2pm
Late Afternoon 2pm-4pm
Evening 6pm-8pm

Anything else you would like me to know:

I agree to receive emails about this support group and related resources. I understand this form does not establish a therapy relationship.

Caregiving Parents Support Group