ENGAGE Enrollment Form - Weekly Parent Support Groups (NO BENEFITS)

ENGAGE Enrollment Form - Weekly Parenting Support Groups (NO BENEFITS)
Welcome to “Nurturing Parents,” a 12-week program that allows parents to connect and support one another. The program is free of charge, with meals provided. The program ends with a graduation for you, and your guests. Please complete all of the information below to enroll in this exciting program!

***BEFORE YOU BEGIN, you will need a copy of all the documents below.***
Please upload a document that shows proof of Lucas County residency. Examples may include: (1) A government-issued ID or (2) A utility bill. *

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Please upload a document that shows proof of having a minor child. Examples may include: (1) Child support order, (2) birth certificate, (3) guardianship documents, (4) report card (with the child's name AND parent name), (5) letter from school (with the child's name AND parent name), or (6) ODJFS Form 7038. *

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Name*

First NameLast Name
Date*

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Occupation (Otherwise, type "unemployed.")*
Highest grade completed or degree earned:*
Gender*

MaleFemaleNon-binary
Email
example@example.com
Number of children in your household:*
Children's ages (please separate with a comma):*
Emergency Contact Information
Emergency Contact's Full Name*
Emergency Contact's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact's Phone Number*
Please enter a valid phone number.
Please list any allergies, including food allergies (or type "none" if there are no allergies):*
How did you hear about this program?*
We at Center of Hope are responsive to our clients, and look for ways to connect them with resources that make life easier and more satisfying. Please indicate if you would like support with any of the barriers listed below:*

FoodClothingTransportationUnemploymentChild Support/CustodyHealthEducationHearing Support/Attorney ReferralsCSEA/LCJC Paperwork HelpSupport at my child's schoolQuestions about my child's school or progress at schoolAccess to mental health servicesNoneOther
If you selected "other," please specify:
Do you have any other goals you'd like Center of Hope to help you meet?*

Gaining a better understanding of my child's school systemGaining strategies for communicating with my child's teachers/principalObtaining a jobHigh School Diploma or GEDEnrollment in CollegeGaining a better understanding of how the Lucas County Juvenile Court System worksGaining a better understanding of how Children's Service worksGaining strategies for having difficult conversations with my childrenChild Support adjustmentsMental Health/WellnessDental/Health CareDriver's License ReinstatementOther
If you selected "other," please specify:
By signing below, I am acknowledging that the above information I provided is accurate. *

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Improving the life outcomes of adults, children, and families in urban settings.

419.861.4400 | 5461 Southwyck Blvd. Toledo, OH 43614 | www.cohfs.org
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ENGAGE Enrollment Form - Weekly Parenting Support Groups (NO BENEFITS)