Carey Guides Workshop Registration

General Information
Student Name
First Last
Age of Student
Gender of Student
(if you prefer to specify)
Race / Ethnicity of Student
Name of Referring Party
First Last
Phone
Email
Relationship to the Student
Reason for Student Referral
Referral Information
Referral Type*
- General / School District
- County Official
Identify the student's challenges.
Describe student's family life to the best of your ability.
Describe student's social life to the best of your ability.
Identity if the student exhibits any of the following risk factors:
- Attitudes, beliefs and thoughts that support delinquent behavior
- Antisocial, hostile or unfriendly toward others
- Long-term pattern of manipulating, exploiting, or violating the rights of others without any remorse
- Weak family ties
Explain risk factors chosen above.
What risk level would you consider the student based on official YASI assessment?
- Low
- Medium
- High
Identify the student's challenges.
Identify the top 3 criminogenic needs / risk factors the student exhibits.
Identify the top 3 strengths the student exhibits.
Additional Information
Is there anything else you would to tell us about the student?
How did you hear about the Carey Guides Workshops?
- Flyer
- Social Worker
- School
- County Official
- Social Media
CAPTCHA
Phone
This field is for validation purposes and should be left unchanged.

Phone: 608-518-3301

E-mail: info@thegoodfight.club

Summer
Tuesday – Friday: 11am – 6pm
Saturday: 11am – 3pm
Sunday – Monday: Closed

School Year (Sept 4 – May)
Tuesday – Friday: 3pm – 7pm
Saturday: 11am – 3pm
Sunday & Monday: Closed

General Information