Fatherhood Development Workshop / Strong Fathers Class Registration

  • Strong Fathers Intake Form

  • Today's Date
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  • Are you completing this Online or at Orientation?*

  • Date of Birth*
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  • Format: (000) 000-0000.
  • Are you currently on
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  • Are you registered for Selective Service*
  • Do you have a disability*
  • Are you a Veteran*
  • Gender*

  • Ethnicity*
  • Are you a parent?*
  • Are you a Father or Caregiver*
  • Are you an expectant Father*
  • Due Date
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  • Are you a US Citizen*
  • Rows
  • Are any of your children on TANF?*
  • Are any of your children currently a part of an open or active DCS Case?*
  • Housing: You are currently?*
  • Are you receiving any of the following*
  • Have you ever been Arrested?*
  • Have you ever been In Jail?*
  • Have you ever been In DOC/Prison?*
  • Where are you incarcerated*

  • Would you like assistance looking for a job>
  • Are you Head of Household?*
  • How engaged are you with your children?*
  • How much time do you spend with your child/children?*
  • After Clicking submit you will be directed to Indiana Career Explorer. Create an account and complete the Career Assessment*
  • We will call you to schedule a time for you to come in and meet with a specialist*
  • Can you pass a drug test
  • Do you have one of the following health insurances?*
  • Are you experiencing any of the following issues

  • Do you need Eye Glasses?*
  • Are you currently receiving Mental Health Treatment or Counseling?*
  • Have you received  Mental Health Treatment or Counseling in the past?*

  • Are you currently prescribed any medication*
  • Are you currently taking any  prescribed medication*
  • When you were growing up, how involved was your father with you?
  • How would you describe the relationship with your father now
  • Do you have an open DCS Case?*
  • Do you have an open Criminal Case?*
  • Have you been vaccinated for Covid 19
  • COVID Impact (Last 6 Months)*
  • ARE YOU VACCINATED FOR COVID 19*
  • After you click submit COMPLETE THE NEXT FORM COMPLETLY to complete the sign up process.
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  • Have you complete Orientation*

  • If you have not completed Orientation, please contact Ms. Nedra at 317-921-5935 to enroll today.

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    Informed Consent for Text (SMS) Messaging

    With your consent, Fathers and Families Center would like to send text (SMS) messages to the mobile number you have provided in our records.

    By providing your informed consent where indicated, you acknowledge that you have understood the information below and agree to participate in our text (SMS) messaging service.

    Purpose and Description: Fathers and Famililes Center’s text (SMS) messaging service is designed to provide you with helpful information, reminders, and notifications via text messages sent to your mobile phone. We may use text (SMS) messages to communicate with you for a variety of purposes, including:

    announcements and reminders of upcoming events and appointments, 
    surveys and polls

    Voluntary Participation: Participation in our text (SMS) messaging service is entirely voluntary. You have the right to refuse or withdraw your consent at any time.

    We do not share or sell SMS opt-in, or phone numbers for the purpose of SMS.

    Benefits and Risks: Benefits: The text (SMS) messaging service aims to keep you informed about Fathers and Families Center by providing an additional method of convenient and timely communication.

    Risks: While every effort will be made to protect the security and confidentiality of information transmitted through text (SMS) messages, there are inherent risks associated with all electronic communication. These risks include unauthorized access, loss of privacy, and potential breach of sensitive information. It is important to be aware that text (SMS) messages may not be entirely secure and could be intercepted or accessed by unintended recipients.

    Potential Costs: Participation in the text (SMS) messaging service may involve standard text messaging charges applied by your mobile service provider. Please consult your mobile service provider regarding any applicable fees or charges.

    "By opting in, you agree to receive SMS messages from Fathers and Families Center, including service updates and meeting reminders. Message frequency may vary. Standard message and data rates may apply. For additional details, please see our full Privacy Policy https://ffcindiana.org/?page_id=3 . To opt-out, reply STOP. For help, reply HELP or contact us at privacy@fathersandfamiliescenter.org.”

     

  • DID YOU READ THE Informed Consent for Text (SMS) Messaging*
  • Click here to Opt in to Receive Txt messages or Opt out and not receive txt messages*
  • Click here to Opt in to Receive Phone Call or Opt out and not receive Phone Calls*
  • Click here to Opt in to Receive Phone Call or Opt out and not receive Emails*

  • RELEASE OF INFORMATION AND PRIVACY POLICY

  • Privacy Policy

  • Please sign and date below

     

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