PEERS® for Teens About YouYour TeenEducationHealth Behaviour Sign Here Parent/Legal Guardian – Name * Parent/Legal Guardian – Name First Name First Name Last Name Last Name Address * Address Address Address City City State State Postcode Postcode Phone * Email * How are you related to the child? * What is your occupation? * Apart from you, is there another caregiver who will be participating in this program? * Yes No Other parent/guardian participating in program * Other parent/guardian participating in program First Name First Name Last Name Last Name What is their relationship to the child? * Other parent/guardian phone Other parent/guardian email Who does your teen live with? * Let me know your preference of how your teen will attend the PEERS® for Teens meetings. * Full program in person Full program online Bootcamp in person Bootcamp online I am flexible Does your child have access to a device larger than a phone at home? * Yes No If you are human, leave this field blank. Next
