Active Parenting

Active Parenting for

Parents of Elementary School Children

and Parents of Teenagers

Tuesdays, beginning April 14th, 2026

5:00 - 6:30 Elementary / 7:00 - 8:30 pm Teens

Please complete the below registration form. The fee for the program is $75 per family. Once we've received your registration, we will reach out to you to schedule a time for you to come to our Levittown office to pay and pick up your materials. If you have any questions, please either email Eileen Doherty at edoherty@yesccc.org or call her at (516) 719-0313 x211. Thank you.

Which class are you registering for?

Active Parenting for Parents of Elementary Children: K - 5th Grade Tuesdays 5:00 pm - 6:30 pmActive Parenting for Parents of Teens: Grade 6 up Tuesdays 7:00 pm - 8:30 pm

Name*

First NameLast Name

Email*

example@example.com

Phone Number*

Please enter a valid phone number.

Ages of children*

School District*

How did you hear about the program?*

Active Parenting is funded through a grant from New York State. As such, we are required to report on the demographics of the attendees. This information will be combined with other attendees and your name will not be included so we ask that you please answer the below questions to enable us to apply for continued funding for this program. If you would prefer to complete these questions over the phone, please call Eileen at (516) 719-0313, x211. Thank you.

Gender

MaleFemale

Please tell us your age group:

Please tell us your ethnicity:

Please tell us your marital status:

Please tell us about your family makeup:

Is your spouse or partner attending this group with you, either from the same or a different location?

YesNo

How many children live in your household under the age of 13?

How many children live in your household between the ages of 13 and 18?

Please tell us your highest degree of education:

Please tell us your total household yearly income (optional):