Please complete form below to receive additional information about registering for the 6-week iTHRIVE Program

Name

First Name

Last Name

Email Address

Phone

Please provide us with best phone number to reach you.

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Please Check One

Please pick from one of the following:

Referred to the 6-week iTHRIVE Program by school

Referred to the 6-week iTHRIVE program by the court

Not referred by court or school but would like to register for the 6-week iTHRIVE program

Other

Please Check One

Please select whether you're a teen or a parent/guardian from the following list:

Teen needing to take the 6-week iTHRIVE program/lass

Parent/guardian needing to register my child to the 6-week iTHRIVE program/class

Other: I'm just interested in receiving more information

Message

Please provide us with any additional information that may be helpful in determining whether you/your child is appropriate for iTHRIVE 6-week program. Also, you can pose any question/s if you are just inquiring about the program.