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Raising Lions Family Parent Mentoring

Parent Intake Form

This brief form helps Pastor Joseph Oster understand your parenting concerns before your session.

Parent Mentoring is provided to adults only. Pastor Joseph does not provide mentoring to minor children.

About You

What is Your First and Last Name?

Name of spouse attending session?

What is Your Email Address?

Phone Number

City, State

I confirm that I am at least 18 years old.

Yes

Not

Your relationship to the child or children you are discussing:

Parent

Step Parent

Legal Guardian

Grandparent/Caregiver

Your parenting concern: What is the primary issue you would like help with?

Select all that apply:

Disrespect or defiance

Discipline or consequences

Rules and boundaries

Inconsistent parenting

Arguing or negotiating

Responsibility/work ethic

Entitlement

Technology/screens

School concerns

Teen behavior

Communication

Lying/Dishonesty

Blended-family or co-parenting concerns

Spiritual leadership

Age(s) of the child or children involved:

Safety and Scope: Is anyone involved in the situation currently experiencing any of the following?

Suicidal thoughts or self-harm

Serious threats of violence

Domestic violence

Suspected child abuse or neglect

Severe substance misuse

Serious psychiatric crisis

Immediate safety concern

None of the above

Raising Lions Family Parent Mentoring is not an emergency, crisis-response, mental-health treatment, or abuse-investigation service. Another professional or emergency resource may be more appropriate depending on the circumstances.

Signature (sign with your finger below)

Signature