Safe at Home Sign up Form

Welcome to Safe at Home: a Healthy Foundations® parenting community for families raising emotionally intense, neurodivergent, adopted, or struggling kids.

Welcome! These 6 week coaching groups provide practical support, and a community of parents who truly understand.

Choose the group that best fits your family's needs, complete the registration information below and we will follow up with details about your group placememt and start date.

You don't have to do this alone!

By joining Safe at Home you agree to abide by our Terms and Conditions.

Name

First NameLast Name

Email

example@example.com

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Where are you located?

Street Address

Street Address Line 2

CityState / Province

Which Safe at Home Parent Coaching Group are you interested in joining?

What are your biggest parenting challenges right now?

What do you hope to gain from this group?

What meeting time would you be most likely to attend? Check all that apply:

Final group times will determined on enrollment and paticipant availability. Every effort will be made to place you in you in a group that works best for your schedule.

How did you hear about us?

One time fee for 6 week program- sign up here to hold your spot. We will get back to you about the time and date. One time add-on for 60 minutes of individual coaching is available with purchase.

Safe at Home Parent Group

$297.00 Quantity

Optional 60 minute Private Coaching

$147.00

Total

Debit or Credit Card
Credit Card Number	Security Code
Expiration Month	Expiration Year

Did the client sign up for the 60 minute private coaching add-on?

One time fee for 6 week program- sign up here to hold your spot. We will get back to you about the time and date. One time add-on for 60 minutes of individual coaching is available with purchase. *

One time fee for 6 week program- sign up here to hold your spot. We will get back to you about the time and date. One time add-on for 60 minutes of individual coaching is available with purchase.