PEERS® for Adolescents Interest Form

New Agenda Coaching

Please complete the form below. After submission, a member of our team will be in touch to finalize your registration. Thanks!

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I am a heading

Parent's Name(Required)

First Last

Child's Name(Required)

First Last

Child's Date of Birth(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Phone(Required)

Is it ok to text you?(Required)

Yes

Email(Required)

Enter Email Confirm Email

Which session are you interested in?(Required)

Fall Session 1: August 4th - November 19, 2026 --- 6:30-8:00pm EST (5:30-7:00pm CST) Tuesdays (Social Coaches/Parent-Guardian) and 6:30-8:00pm EST (5:30-7:00pm CST) Thursdays (Adolescent Group).

Fall Session 2: August 4th - November 19, 2026 --- 6:30-8:00pm PST (7:30-9:00pm MST) Tuesdays (Social Coaches/Parent-Guardian) and 6:30-8:00pm PST (7:30-9:00pm MST) Thursdays (Adolescent Group)

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