Group Parenting Education

Parent to Child (P2C) Group Parenting Education Referral Form

If you are interested in applying for the P2C Group Parenting Education session,
please complete the following referral form. Upon review, our Parent Educator, Mollie Acker, will contact you to schedule an intake session. If you have any questions about this process, please refer to the Information Packet or contact Mollie at molliea@canopycenter.org.

Client Information

Client's Name

First Name *

Last Name *

Birthdate

Address

Country

Address Line 1 *

City *

State/Province *

Postal Code *

Phone Number

Preferred Method of Communication

Call, Text, Email etc

Preferred Pronoun/s

4jyqfg115d3d

Are your parenting classes court ordered?

Child(ren)'s Information

Child(ren)'s Name/s

Child(ren)'s Age/s

Child(ren)'s Preferred Pronoun/s

Please include names with pronoun/s if more than 1 child

Attorney/s and/or Other Professional Parties Involved

Professional Party's Name/s

Email/s

Phone Number/s

You helped us make an impact in 2024.

Many of the children and families we serve receive services over the course of a year or more. Canopy Center is consistency, a safe place and hope for the future.