Be Brave Bridge Application Form

Little Warriors Be Brave Bridge Online Program Application Form
Please select your preferred program: (NOTE: One referral per individual is required.)
Do you have access to a computer or device so you can access the online program?
If you answered 'No', how do you plan on accessing the online program?
Are you a parent/caregiver of a child who has been sexually abused, or suspect there has been sexual abuse?
Are you wanting your child to attend Little Warriors Be Brave Ranch in the future? (if your child is currently attending or is a graduate, please select 'Yes').
Please explain if you answered 'No' or 'Unsure':
Parent/Caregiver Full Name

First NameLast Name
Parent/Caregiver Email
example@example.com
Parent/Caregiver Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
If you are a TEEN completing this application:
1. Is your parent or caregiver aware you are making this referral?
Parents/Caregivers and Teens complete:
How will taking this program help you? What are you hoping to gain by the end of the program?
Briefly provide some information around the abuse, e.g when was it disclosed; how old was the child, over what period of time did it occur, did the child/youth know the abuser, has it been reported, was there any treatment after disclosure? Any other information you feel comfortable providing.
Parents/Caregivers and 16-18 year old Teens complete:
Has any child you've been a parent/caregiver to been connected with the Be Brave Ranch? (check ALL that apply)
Name of Child connected to the Be Brave Ranch:
Parents/Caregivers and Teens complete:

What resources/supports do you or your child have/use? (Examples: mental health therapist or program; support from social services (please explain); spiritual support; cultural activities; participating in sports, clubs or organizations; school program/extra curricular; family support; friend/s, etc).
Please explain as much as you feel comfortable in the box below:
Are there any environmental, family or personal stressors that could stop you from being successful in working through the modules on a regular basis, as well as meeting with a Coach on Zoom? (Examples: work hours or work stress; finding a quiet/private space to do the modules/Zoom calls; physical health issue e.g. fatigue; mental health - eg. anxiety, ADHD, learning disability; lack of support; heavy school term; upcoming court; travel; etc.)
Please explain as much as you feel comfortable in the box below:
If your referral is placed on a waitlist due to limited space, is there something you want us to know that would help prioritize your referral?
Information required to set up a username and password:
Full Name of Program Participant

First NameLast Name
Date of Birth

YearMonthDay
4 digit year, 2 digit month, 2 digit dayDate
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Program Participant Address
Program Participant City
Program Participant Province
Program Participant Postal Code
By clicking “Submit,” you acknowledge and agree that the email addresses provided will be automatically enrolled in the Be Brave Bridge Foundations module, which contains the core program material and serves as an immediate resource.

Upon completion, participants will receive a Certificate and an opportunity to access advanced module series on Attachment and Connection, Trauma-Informed Strategies, and Family-Focused Solutions, which include specialized psychoeducational coaching support. Participants will also have an opportunity to access Special Topics modules covering areas such as online safety and self-harm.

We look forward to supporting you on your learning journey!
Hidden Fields
Contact Record Type ID
Owner ID
Application Record Type ID
Program ID
Should be Empty:

Little Warriors Be Brave Bridge Online Program Application Form

If you are a TEEN completing this application:

Parents/Caregivers and Teens complete:

Parents/Caregivers and 16-18 year old Teens complete:

Parents/Caregivers and Teens complete:

Information required to set up a username and password:

Hidden Fields