HopePoint Groups & Classes Interest Form
Thank you for your interest and for trusting us to partner with you and your family. We will offer groups and classes when we have enough interest and as we are able. After you complete and submit the information below, you will be added to our class waiting list and will be notified when we begin to schedule for the class or group you are wanting.
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Participant Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
Confirmation Email
Please enter again to confirm
Do we have permission to email you?
*
Yes, and please add me to the HopePoint email list for more information & resources. (You can unsubscribe at any time.)
Yes, please. (You will only be contacted when there is a class offered you selected.)
No, thanks. (You will receive a phone when there is a class offered that you selected. By clicking this option, you give permission to receive calls.)
Other
Please complete if another adult from your household will also be a participant.
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Is a child/teen in your home a client of a Provider at HopePoint?
*
Yes
No
Child/Teen was a client in the past.
Child/Teen is on the waiting list.
Other
What are the ages of children/teens in your home?
*
Ages only please
What group/class interests you? (You can select more than one) Not all groups & classes are currently being offered.
*
I need more information to know what to select, so please contact me.
Making Sense of your Worth (MSOYW)
Beneath the Mask (for teen adoptees)
TBRI® Caregiver Training (Parenting Foster/Adoptive Children ages 3-12)
TBRI® Caregiver for Teens Training (Parenting Foster/Adoptive Teens ages 12 and up)
Parenting for Positive Self Worth
TBRI® Implementation and Support Group (Held Virtually Once a Month)
Other
Do you have insurance?
*
Yes
No
Other
Insurance Provider:
E.g. Blue Cross Blue Shield, Meritain, United HealthCare, Aetna/Sunflower/United Medicaid etc.
Insurance ID Number (Sometimes called Member Number or Policy Number)
Group Number (if applicable):
Who is the Main Subscriber of this insurance plan?
What is the Main Subscriber's Date of Birth?
Which type of class do you prefer?
*
In-Person
Virtual
It depends on the current situation.
Other
I can attend classes or groups
*
during the weekday between 9am and 2pm.
during the evening only.
Other
How did you hear about this class or group?
*
Submit
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