"Parents Place is a life saver for me and my kids!" - Kelly

"I thought the class was going to change my kids, but it really changed me." – Sarah

" I don’t know what I would have done without Parents Place." – Carla

"The Supervised Visitation staff has become like family to me and I will always be grateful for keeping my family together." – Neil

Parents Place focuses on strengthening families and protecting children through community education, parenting classes, support groups, child advocacy and supervised visitations.

Our Mission

Find out about our organization, mission, our methods, and the results of our decades of advocacy.

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Community Education

Check out all the classes and groups we offer for parents and kids within our Community Education program.

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Supervised Visitations

Read about our Supervised Visitation program used to reunite disrupted families in a safe and nurturing environment.

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Upcoming Events

Printable Flyer

Email our staff or call 262-549-5575 for more information or to register.

FAMILY INTAKE FORM

Date *

Date

YYYY

Group/Class Attending *

How did you hear about Parents Place? *

Do you have a County Worker? *

*If yes, who?

Your Name *

Your Name

First Name

Last Name

Date of Birth *

Date of Birth

YYYY

Gender *

Marital Status *

Name of Spouse

First Name

Last Name

Address *

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

Phone

(###)

###

####

Email Address

Add to Email List?

Yes

**If you do not have email, would you like us to add your name to our mail list?

Yes

Children:

Name

First Name

Last Name

D.O.B

YYYY

Gender

Children Attending Childcare/Class:

Name

First Name

Last Name

D.O.B.

YYYY

Gender

Children Attending Childcare/Class:

Name

First Name

Last Name

D.O.B.

YYYY

Gender

Children Attending Childcare/Class:

Name

First Name

Last Name

D.O.B.

YYYY

Gender

Children Attending Childcare/Class:

Name

First Name

Last Name

D.O.B.

YYYY

Gender

Children Attending Childcare/Class:

Our funding sources require the following questions:

Estimated Family Income *

Race *

Primary Language Spoke in the Household *

Are you or have you ever been a member of the Armed Forces? *

Have you or your child ever experienced trauma? *

*Everything on this form is completely confidential and will not be used outside of Parents Place's Community Education Program

Signature Required For Completion *

By signing my name below, I certify that I have read the above information. My signature also certifies that all information is true. I also understand I am responsible for all fees not paid. A photocopy of this document is as valid as the original. You may receive a copy of this document upon request.

Parents Place focuses on strengthening families and protecting children through community education, parenting classes, support groups, child advocacy and supervised visitations.

Our Mission

Community Education

Supervised Visitations

Upcoming Events

About Us

Quick Links

Contact Us