Incredibly Elev8ed CiC Parenting: Course Registration Form

Parenting Course Registration
To be completed by each Incredibly Elev8ed CIC will hold the information you have provided for the purpose of pastoral care, administration and to keep you informed of their other services and activities. Information you provide will not, without your permission, be disclosed outside of this organisation.
Please Confirm*

I am the parent / carerI am referring this family with their consent
Course Choices:

Please check details of courses thoroughly before booking
Type a question*

TEEN Triple P - (Online) - 10am-12 Noon) Friday 17th April 2026 for 5 weeks.
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0-12 Triple pFear LessStepping StonesOther - Please specifyOther
- Full Name*
  
  First NameLast Name
- Address*
  
  Street Address
  
  Street Address Line 2
  
  CityState
  
  Zip CodeCountry
- Local Council / Borough
- E-mail*
  Parent 1
- Contact Number*
  
  Area CodePhone Number
- Birthdate
  
  MonthDayYear
  Date
- Child(ren)s Details*
- Are any of these current to you / your family? (either yourself or your child(ren)
  
  Mental IllnessChild Protection PlanChild In Need PlanLong- Term Health IssueEHCP PlanOther
- Do you require any support with speaking or writing in English?
  
  NoYesOther
- Monitoring:
- Do you receive any additional support for any of your children?
  
  YesNoAwaiting ReferralAwaiting AssessmentOther
- What would you like to achieve from attending a course with us?
- Please Share your Ethnicity as you identify
  i.e. White British, Black Caribbean, Romany Traveller, Mixed Race
- Course Pathway
  
  Self ReferralGPCourt OrderSocial Worker/ CafcassCharity/ CICChildren's CentreHealth VisitorCAMHSOther
- I give permission to be contacted at a later stage to evaluate how effective the parenting support is still proving?
  
  YesNo
- I would like to be contacted about future courses, seminars, webinars, events etc?
  
  YesNo
- How did you hear about the programme?
- Professionals:
  
  If you have referred this family please give your details below
- Email
  example@example.com
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Phone Number
  
  Area CodePhone Number
- Should be Empty:

Parenting Course Registration

Course Choices:

JOIN WAIT LIST

Professionals: