F.A.M.I.L.Y. SafeLine-Support Request
If a child in your life is struggling with bullying, isolation, or other challenges you can reach out to F.A.M.I.L.Y. through this SafeLine-Support Request. Our goal is to listen, encourage, and help connect families with positive support and community resources.
Important Notice:
F.A.M.I.L.Y. is a community advocacy organization. We are not a counseling service or emergency response provider. If a child is in immediate danger, please contact local authorities or emergency services.
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Contact Information
This information allows our team to follow up and offer support or connect you with helpful resources.
Your Name
First only is okay if you don't want to provide last as well.
Relation to child
Please Select
Parent
Guardian
Other
Email
example@example.com
Phone Number (Optional)
Please enter a valid phone number.
Format: (000) 000-0000.
Preferred Contact Method
Email
Phone
Text
Either is fine
Best Time to Reach You
Morning/Afternoon/Evening
Your information will be kept confidential and used only to respond to your request for support.
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About the Child
This information helps us better understand how we may offer encouragement or connect families with helpful resources.
Age Range of the Child
5-7
8-10
11-13
14-16
17-18
School Grade (Optional)
Please Select
K-5
6-8
10-12
What Type of Support is Needed? ( Select All That May Apply)
Is the Child Aware You Are Reaching Out?
Yes
No
Not sure
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How Can We Help?
If you are comfortable sharing, tell us a little about what's going on and how F.A.M.I.L.Y. may be able to offer encouragement or support
You may share as much or as little as you feel comfortable. Our goal is simply to listen and help connect families with encouragement and helpful resources.
What Kind of Support Would be Most Helpful?
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Permission & Follow-Up
Before submitting your request, please review the information below and confirm that we may follow up with you.
I give permission for a representative of F.A.M.I.L.Y. to contact me regarding this SafeLine-Support Request.
*
I understand that F.A.M.I.L.Y. is a community advocacy organization that provides encouragement and connections to helpful resources. F.A.M.I.L.Y. is not a counseling service or emergency response provider.
*
I would like to receive occasional updates about F.A.M.I.L.Y. programs and community initiatives. (Optional)
Send Support Request
Should be Empty: