Kinship Programs

Register for this event
Event Location
Event Time / Details
Email (we will use this email to send the class Zoom link)*
Number of Teens Attending?*
Teen 1 Name*
First Last
Teen 1 Email*
Teen 1 Phone*
Teen 1 Age*
NOTE: Minimum age requirement of 14 years or at least 8th grade or higher.
Please enter a number from 1 to 100.
Teen 1 Grade in School*
Name of School District Teen 1 Attends?*
Teen 1 Gender*
- Male
- Female
Teen 1 Race/Ethnicity*
- White
- Black/African American
- Hispanic/Latino
- Asian
Teen 2 Name*
First Last
Teen 2 Email*
Teen 2 Phone*
Teen 2 Age*
Please enter a number from 1 to 200.
Teen 2 Grade in School*
School District Teen 2 Attends?*
Teen 2 Gender
- Male
- Female
Teen 2 Race/Ethnicity
- White
- Black/African American
- Hispanic/Latino
- Asian
Please choose the number of children, provide their names and ages.
Address*
Please list the address you would like the handouts mailed to.

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Parent or Guardian Name*
First Last
Parent or Guardian Email*
Parent or Guardian Phone*
Who referred you to COBYS?*
- Counselor
- School
- Doctor
- County Agency
- Youth Aide Panel
- Internet Search
Name of person who referred you:
Comments
Phone Consent*
I agree to the following phone consent:
By submitting this form/clicking here and providing your phone number, you consent to receive informational text messages (e.g. class and event reminders, etc.) from COBYS Family Services at the number provided. Msg & data rates may apply. Msg frequency varies. Unsubscribe at any time by replying STOP or clicking the unsubscribe link (where available). HELP for assistance. Privacy Policy & Terms www.coby.org/privacy-policy.
Consent*
I agree and authorize the information below.
By submitting this registration I authorize and agree to the following:
I authorize COBYS Family Services to provide demographic information (i.e. race, age, etc.) to funding sources and release attendance and/or participation information upon request to the funding source and the participant’s referral source.
I agree and understand COBYS Family Services provides educators. Therefore, I will not ask anyone from COBYS to be called for testimony for any future proceedings. COBYS will acknowledge attendance to classes but no other information.
I understand that COBYS staff are mandated reporters, and are required by law to report to the appropriate agency when there is reasonable cause to suspect child abuse.
Parental Consent*
I agree to this Authorization.
I give my permission for my child to participate in this program, as well as consent to have audio recording of the program if needed for instructional purposes. All program staff are bound by professional ethics of confidentiality.

Kinship Programs

Registration

COBYS Permanency Unit