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NAME OF ADULT/RESPONDENT
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NAME OF DEPLOYED SOLDIER
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RELATION TO SOLDIER
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ARE YOU INTERESTED IN ATTENDING A FAMILY SUPPORT FORUM GATHERING?
Yes No Contact Me with More Information |
If Yes, which week day evenings fit your schedule
Monday Tuesday Wednesday Thursday Friday |
WILL JOIN FOR SNACKS 6:00 TO 6:30PM
Yes No |
WILL JOIN FOR GROUP PROGRAM 6:30-7:30PM
Yes No |
NURSERY NEEDED (FOR AGES 5 AND UNDER) AVAILABLE (FREE) BETWEEN 5:30PM-8:00PM
Yes No Contact Me with more information |
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| CHILDREN NAME(S) |
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| List Age(s) as of 3/1/10 |
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| NON-FAMILY INTERESTED IN PARTICIPATING |
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| Adult Education Topics (Check all that are of interest) |
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STRESS AND ANXIETY MANAGEMENT
PTSD- WHAT IS IT?
COPING WITH ALONENESS
SINGLE PARENTING: WHO IS IN CONTROL AT MY HOUSE?
COMMUNICATION SKILLS
RESOLVING CONFLICTS: DEALING WITH DIFFICULT PEOPLE
IN THE DANGER ZONE: EFFECTS ON YOUR SOLDIER
HELPING THE COMBAT VET WITH SLEEP ISSUES
SUBSTANCE ABUSE IN THE FAMILY
DEPLOYMENT AND REDUCING THE EFFECTS ON KIDS
FINDING TIME FOR OURSELVES
KEEPING LOVE ALIVE: DOES ABSENCE MAKE THE HEART GROW FONDER?
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| LIST THE TOPICS YOU WANT A SESSION ON/OR LEARN ABOUT |
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| YOUTH EDUCATION TOPICS (Check all that are of interest) |
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I SERVE TOO WHEN MY PARENT'S DEPLOYED
WHOSE RESPONSIBILITY IS IT ANYWAY?
COMMUNICATION SKILLS
WHAT AM I FEELING?
WALKING THE TALK- KEEPING IT REAL
WHEN NO ONE IS WATCHING: MY CHARACTER
BLOWING YOUR TOP? DEALING WITH ANGER
EXPECTING THE UNEXPECTED: DEALING WITH CHANGE
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| LIST THE YOUTH TOPICS YOU WANT A SESSION ON/OR LEARN ABOUT |
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| YOUTH SPECIAL EVENTS PROGRAMING (Check all that are of interest) |
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Movie Night
Horse Back Riding
Climbing Wall
Fishing Tournament
Game Night
ASU Sporting Events
Ropes Course
Scavenger Hunt
Picnic
Costume Party
Bible Study
Arts Crafts
Swimming Lessons
Pizza Party
Chuck E Cheese
Skating
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| LIST OTHER SPECIAL EVENTS/ACTIVITIES YOU WOULD BE INTERESTED IN |
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ARE YOU INTERESTED IN INDIVIDUAL OR FAMILY COUNSELING?
Yes No Contact me with more information |
| WHAT OTHER SERVICES DO YOU OR YOUR FAMILY NEED WHILE YOUR SOLDIER IS DEPLOYED? |
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