Live Like Sam · LLS THRIVE Information Request Form

Program Registration

Contact Information

Name

*

First Name

Last Name

Email

*

What is your role?

*

I am the parent of a student

I am an educator/coach

I am a student

THRIVE programs

Which type of THRIVE programing are you interested in?

THRIVE Programs

*

THRIVE Cohorts - for grades 9-12

THRIVE Cohorts - for grades 5-8

If you are interested in the summer session of Cohorts for grades 9-12, what time of day is best for your student for the weekly meeting?

Please check all that apply. Unfortunately we cannot guarantee that we will have cohort sessions at your preferred time of day.

morning (8 am - 12 pm)

afternoon (12 pm - 5 pm)

evening (5 pm - 8 pm)

Tell us about yourself (optional)

Why are you interested in the THRIVE program?

Help us reach others!

Where did you hear about the THRIVE program?