Military Strengthening Families Program (MSFP)

MILITARY STREGTHENING FAMILIES PROGRAM (MSFP)

PROGRAM REGISTRATION FORM
ABOUT THE PROGRAM:

The Military Strengthening Families Program (MSFP) is an evidence-based family skills training program for high-risk and general-population families recognized nationally and internationally. Parents and youth attend weekly MSFP skills classes together, learning parenting skills and youth life and refusal skills. The program will begin with a family dinner that Cape Assist provides. After dinner, the parents and youth will separate into workshops where weekly lessons and training will be held. The parents and youth will rejoin each other for the remainder of the program, where a family project or lesson will be done.

The program is a 7-week program that meets twice or once a week, depending on the age group of the program, and is FREE to attend for any family residing in Cape May County, New Jersey. Upon completion of the program, families will be rewarded with a gift card.

PROGRAM FORM REQUIREMENTS:

To complete this form for the program, it will ask for information for all individuals that are currently residing in the household. Information such as gender, race, birthdate, employment, and other information will be required to complete the form.

Funders require this information about the program to ensure the authenticity of the program and the participants in the program. The information will never be used for purposes other than to validate the program and attendees of the program. Information entered, transmitted, and temporarily stored by Cape Assist will be secured using HIPPA-compliant security and encryption.

Depending on the household size, this program form can take between 5 and 10 minutes to complete. Families attending the program more than once in the same calendar year will not be required to complete all fields in the form unless their household information has changed.

Military Status:*
Program Setting/Location:*
Program Instructor:*
Age Group of Children in Household (select all that apply):*

3-5 Years Old6-11 Years Old10-14 Years Old

Primary Participant's Contact Information:

Information on the primary person attending the program.
Participant's Name:*

First NameLast Name
Participant's Email Address:*

Confirmation EmailProvide a valid email address to access program information and for gift card. Be sure to check your spam folder for missing emails.
Participant's Phone Number:*
Please enter a valid phone number.
Do you wish to receive text messages about the program for the phone number provided:*
Message and data rates may apply. Participants can opt-out of messages by texting "STOP" to (609) 522-5960.
Participant's Address:*

Street Address

Street Address Line 2

CityState

Zip Code

Household Demographic/Employment Information

Complete for everyone living in the household.
Number of ADULTS living in your household (including yourself):*
Adults include anyone 18 years of age or older
Number of CHILDREN living in your household:*
Children include anyone 17 years of age or younger

Household/Program Summary
Total Household Size:*
Total Adults Participating in the Program:*
Total Children Participating in the Program:*
Total Household Gross Income (before taxes):*

Family Dynamics
Is there anything you'd like to tell us about your family?*
Are there any good times that your family has had together that you would like to share?*
Are there any hard times that your family has had together that you like to share?*
Is there anything that you would like to see changed in your family?*
All children learn differently and have different learning styles. Do your children have any special talents or needs that we should be aware of?*

Military Strengthening Families Program (MSFP) Agreement & Consent
Information Consent:

I, {participantsName}, agree that any and all information provided on the application/form for the Strengthening Families Program conducted by Cape Assist is accurate and true. In addition to the accuracy and truthfulness of the information provided, I agree that the information may be shared with any parties that Cape Assist deems necessary for funding and reporting purposes. I acknowledge that Cape Assist will never use or sell my information for any purposes outside the program's scope or the organization's mission of focus and that Cape Assist will take the necessary measures and protocols to protect any information provided.

Program Confidentiality:

I, {participantsName}, understand that any information discussed in the program is strictly confidential. I acknowledge that all program participants are expected to keep all discussions during the program confidential to protect all participants and the program's integrity. Cape Assist may reserve the right to break any confidential agreement in the case of an event where a participant presents a threat to themselves or others.

Attendance Policy/Program Requirements:

Participants of the program MUST attend all program sessions and complete the required program forms and tests to successfully complete the program and receive any incentive(s) from the program. Participants who receive any incentive(s) during and/or after the program has ended and fails to uphold the attendance policy and/or complete the program requirements, such as the Program Form, Pre/Post-Tests, and any other required program document the facilitator deems necessary, may be asked to return any incentive(s), or such incentive(s) may be canceled without notice to the participant. If a participant should find themselves unable to attend a session, the participant must contact Cape Assist at (609) 522-5960 or reach out directly to the program facilitator. Cape Assist reserves the right to make exceptions to the attendance policy or program requirements.

Media Consent:

I, {participantsName}, agree and have consent for all the participants listed on this form that their names, photos, ages/grades, attending schools, likenesses, appearances, images, voices, videos, and artwork may be used for promotional, advertising, and educational material including but not limited to print, digital, direct mail, and for use on the internet for an indefinite duration without compensation. I acknowledge that this consent will also cover any virtual sessions conducted through video conferencing, such as Zoom or any other video and/or phone conferencing platform that Cape Assist may utilize as part of the program. In addition, I agree that I am responsible for removing any person(s) I do not have media consent and/or are not listed on this form. The facilitator(s) of the program will give prior notice before initiating any photo capturing and/or recordings. At this point, any participant can object and request to be exempt.

Termination of Agreement & Consent:

I, {participantsName}, acknowledge and agree that this agreement and consent will be binding and effective immediately upon completion. The agreement and consent will remain effective until either party revokes or terminates the agreement. Termination of agreement and consent can be made in writing and sent to Cape Assist at 3819 New Jersey Avenue, Wildwood, NJ 08260, or by email at info@capeassist.org. Termination of agreement and consent can also be made by contacting the program facilitator directly.
Primary Participant's Name:*

First NameMiddle NameLast Name
Primary Participant's Signature:*

Clear
Today's Date:*

MonthDayYear
Date
Should be Empty:

MILITARY STREGTHENING FAMILIES PROGRAM (MSFP)

Primary Participant's Contact Information:

General Program Information

Household Demographic/Employment Information

Household Demographic/Employment Information (ADULTS)

Household Demographic/Employment Information (CHILDREN)

Household/Program Summary

Family Dynamics

Military Strengthening Families Program (MSFP) Agreement & Consent