Starting Strong Enrollment Form

Starting Strong Workshops are an introduction to People Safety Skills for young children ages 4-6. Storytelling, puppets and interactive role-plays teach children simple but powerful skills to: act aware and confident, set boundaries, stop unwanted touch, handle unkind words, be safe with strangers, and get help from adults effectively, even when they are busy. This two-hour training introduces everyday safety skills (NOT physical self-defense skills) and guides adults in practicing these skills together with their children. At least one parent or guardian is required to attend with their child/children. This workshop helps answer the question, “How can we teach our children to be safe without scaring them?” in a fun, age-appropriate way. This class is limited to 12 students.
Fees: $45 per child. Discounts of $10 will be given if more than one child enrolls from the same family in the same class. Scholarships may be available based on financial hardship considerations. If you need a scholarship, please enclose a brief letter describing your situation and a payment of whatever you can afford. Payment by Visa, MasterCard or Discover is also available.
To Register: Please send the enrollment form with your payment to Kidpower, 10 Boulder Crescent, Suite 100, Colorado Springs, CO 80903. We limit our workshop size and must have your deposit in order to reserve your spot.
Program Date and Location*
NOTE: We will do our best to enroll your child(ren) in this class if there is an opening. We do recommend that you put your name on our wait list if you are interested in our upcoming dates. There may be last minute switches, particularly during cold and flu season, which may provide an opening. We will post the dates for our next four workshops in May.
First Name of Person Enrolling Child:*
Last Name of Person Enrolling Child:*
Relationship to Child*
Are you the legal guardian of the child?*
- Yes
- No
Child Information
Child First and Last Name
Birthdate
Age
School Attending & Grade (if applicable)
Add another child
Contact Info
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Primary Phone Number*
Other Phone
Email*
Best time(s) to reach you
How did you hear about Kidpower? (check all that apply - Ctrl Click for multiple selections)
We LOVE referrals, please tell us which friend or family member referred you.
If therapist or "other", please specify
Enrollment
How many children are you enrolling?*
Are there any health problems or special circumstances that would be helpful to know about your child?*
- Yes
- No
Does your child have any learning or emotional issues and/or past experience with abuse that would be beneficial for us to know about in preparation for class?*
- Yes
- No
If you answered "Yes" to either of the above questions, please explain here.*

This information is secure and will remain confidential but if you would prefer to disclose offline, please call us at (719) 520-1311.
Do you have specific safety concerns for your child?*
Payment Method*
Cash or Check - Space is limited. Payment or other financial arrangement is required to hold your spot.

Online - you will exit this website to check out on PayPal with either a PayPal account or credit card.

Other - Check this box if you would like to apply for scholarship funding or if you have applied for Victim Compensation (or will apply.) Specify below which option and we will contact you.
- Cash/Check/Other
- Online Payment
Total
$0.00
A deposit (or other financial arrangement) is required to confirm your enrollment. Balance is due the day of the workshop. Please make your checks payable to:

Kidpower of Colorado
We will now continue to PayPal to finalize your enrollment.

Starting Strong Enrollment Form

Starting Strong Enrollment Form

Child Information

Contact Info

Enrollment

A deposit (or other financial arrangement) is required to confirm your enrollment. Balance is due the day of the workshop. Please make your checks payable to:

We will now continue to PayPal to finalize your enrollment.