CORE Teen Registration

Please use this form to register a Teen Participant.

Contents

contact information
personal information
How'd you find out?
Conflict Handling
Stress Handling
Feelings about age
How to improve
Feelings about you
What are you good at
Are you able to communicate
Interests&Hobbies
Feelings about future
One Dream
How's the Family
How's the 'other' life
How do you feel about coming to CORE
Anything else

Please provide the following contact information:

First Name

Last Name

School/Grade

Work Phone

Home Phone

FAX

E-mail

MySpace
Please describe yourself:

Date of Birth

Gender Male Female
How did you find out about the seminar?
How do you handle conflict with friends, family, or others in your life?
How do you handle stress in your life?
How do you feel about being your age?
If you could improve your life, what would you change?
How do you feel about yourself?
What are you really good at?
Do you feel that you are able to communicate well with people in your life?
What are your interests, hobbies or activities?
How do you feel about your future?
If you knew you had one dream that WOULD come true, what would it be?
How do you feel about your family life?
How do you feel about your personal relationships other than your family? (Friends, girlfriends, boyfriends, teachers, empoyers, etc.)
How do you feel about being in the seminar?
Is there anything else you'd like us to know about you?

By Checking here I affirm that my answers have been honest and as complete as possible.

Jim Connell
Copyright © 2007 [CORE Seminars, Inc.]. All rights reserved.
Revised: 01/12/07