ReRooted™ Reunification Coaching Waitlist & Intake Form

ReRooted™ Reunification Coaching Waitlist & Intake Form
Thank you for joining the waitlist. ReRooted™ Reunification Coaching is a trauma-informed, relationship-centered support program designed to guide families through reconnection and repair after separation, disruption, or high-conflict transitions. Our coaching approach integrates therapeutic insight with structured tools to rebuild trust and clarity between caregivers and children.
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
What best describes your situation?
DSS/Child WelfareFamily CourtBothNeither
0-5 years6-10 years11-13 years14-17 years18- (young adult)
One-on-One CoachingFamily CoachingPeer Group Coaching
In-Person (NC only)Virtual
What area or county do you currently live in?*
Are you interested in the full 6-week ReRooted™ Program?
Would you like to receive additional resources while you wait?*
What are your main goals or concerns with reunification?
Immediate1-3 months3-6 monthsOther
Should be Empty: