Podcast Form

1
How did you hear about On the Hard Days?* This field is required.
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Instagram
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Word of Mouth (friends, family, therapist, etc)
Podcast listening plaform (ie. Apple, Spotify, etc)
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2
Name* This field is required.
First Name
Last Name
3
Email* This field is required.Please note this is how we will be reaching out to you so make sure this is an up to date form of communication!
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4
I am the parent or primary caregiver of a neurodivergent child* This field is required.
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The next few questions are going to ask about you, your family and your mental health journey. I understand these can be delicate topics and privacy is important. I want to respect you and your family. Please only share what you are willing to discuss with me.

I think it is important for us to discuss these, sometimes sensitive and difficult, topics so that we can build community.

I want to thank you for being willing to share these pieces of your life with me and the On the Hard Days community and recognize that it can be hard to open up about some of these topics.

It is so important that we talk to one another and share our experiences so we can all feel less isolated and just a little bit better.

Even on the hard days, we are not alone.
6
Tell me a little about your kids.* This field is required.Age, Gender, Role you play in their life (ie. mom, dad, Grandparent or other family member parenting a child, Foster Parent caring for a child long term, or Step Parent functioning as a primary caregiver, etc.)
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Tell me a little bit about your family:* This field is required.Are you in the US or a different country? Do you have a large family or small? Are you an adoptive/foster parent? What does your family structure look like?
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Tell me a little bit about what you struggle with as a parent to a neurodivergent child:* This field is required.Examples: "I find it hard to deal with the aggression my child displays....", "We just got my toddler diagnosed and navigating that process has put a strain on our resources...", "My child is struggling and the school has been so hard for me to deal with..." "I am finding it so hard to connect with my neurodivergent teen...." "My family/partner/friends do not understand the life I live..."
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Tell me a little bit about you both before and after kids:* This field is required.How is your mental health? Do you work outside the home? Do you or did you have any hobbies? Does faith play a role in your life?
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10
Do you, your spouse or your child(ren) have any diagnoses you're willing to share?* This field is required.Please format as one line per individual: "Self/Daughter/Son/Child/Spouse: Diagnoses" if you have multiple children with diagnoses please use a descriptor like their intial or their age (whichever you are comfortable sharing)
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Are there any topic not covered in the previous questions you'd like to chat with me about?* This field is required.Example: Are you part of the LGBTQ+ Community? Do you face predjudice in your life because of your race, socio-economic status, etc? Are you a veteran, active service member or military spouse? Are you an Educator, Special Education Advocate or Therapist or other professional who works with other Neurodivergent people or in an adjacent field?
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12
Are you a member of the Mothers Together Community?* This field is required.(This is just for our records, being a member of the community does not make you any more or less likely to be invited to participate on the podcast.)
YESNO
13
By Signing below you agree to share audio from our discussion and any of the above details (excluding your contact information and last name) on publicly available platforms including but not limited to: Social media sites like Instagram, Facebook, Tic Tok, etc; Podcast platforms like Spotify, Apple Podcasts, Google Podcasts, etc; Video sites like Youtube; and our Mother's Together Community (Hosted on Marco Polo).* This field is required.
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