I'RAISE Girls & Boys International Corp. Parent Rise Support Group
Parent Rise support group is open to all parents in New York State. We meet every Tuesday from 7:00pm-8:15pm
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Please write the first and last name of your child/ren who particpates in I'RAISE programs. If none, please state none. *
Parent/Guardian Name *
(First and last name)
Parent/Gaurdian Date of Birth *
MM
/
DD
/
YYYY
Parent/Gaurdian gender *
Required
Which best describes the race/ethnicty of Parent/Gaurdian completing this form? *
Required
Primary Language Spoken *
Required
Parent/Gaurdian Email Address *
Parent/Gaurdian mobile phone number *
Prefferred method of contact *
Full Address of parent/gaurdian *
Please Enter House Number, City, State, Zip Code
Parent/Gaurdian Employer *
Please list the name of your current employer, if not employed, please state "unemployed"
Second Parent/Gaurdian Name *
First and last name
Second Parent/Gaurdian Email
Second Parent/Gaurdian Mobile Number
Does second parent/gaurdian reside with you and your child/ren?   *
Which of the following best describes your current relationship status? *
Required
Does any of the following apply to your child since the COVID-19 crisis began? *
Required
Are you (parent/guardian) and/or any other parent/guardian in the home experiencing any of the following since the COVID-19 crisis began? *
Required
 Do you receive any of the following services? *
Required
Do you need any of the following resources as a result of COVID-19? *
Required
What are some topics you would like to discuss during our parent groups?
Is there anything else you want to share with us?
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