I Have a Voice Sign Up Form

I Have a Voice….ELLA’s Therapeutic Program for Children with Incarcerated Parents and/or Loved Ones

2.5 million children in America have a parent and/or caregiver incarcerated. Often these children feel isolated, ashamed, confused, and/or guilty, all through no fault of their own. The “I Have A Voice” program is a therapeutic program that brings these children together to help them find their voice in a loving and supportive environment, surrounded by other children who share their experience and pain.

For more information, please contact Charity Lee of The ELLA Foundation by clicking here, by calling 210-601-9551, or by filling out the registration form below.

Program Begins: May 13, 2013

Time: 6-8pm

Meets: The 2nd Monday of every month

Where: Greater Faith Institutional Church, 3514 Martin Luther King Dr., San Antonio (Click here for Google Maps)

To participate in workshop, fill out and submit the form below:

Parent Information
Name of Parent/Caregiver:*
Address:*
City:*
State:*
Zip Code:
Phone:*
Email of Parent/Caregiver:
OK to leave a message at this number?:*
- Yes
- No
Children Information
First Child
Name of Child:*
Child's Birthday:
Child's Age:
Child's Grade Level:
Child’s T-Shirt Size:
Second Child
Name of Child 2:
Child's Birthday:
Child's Age:
Child's Grade Level:
Child’s T-Shirt Size:
Third Child
Name of Child 3:
Child's Birthday:
Child's Age:
Child's Grade Level:
Child’s T-Shirt Size:
Fourth Child
Name of Child 4:
Child's Birthday:
Child's Age:
Child's Grade Level:
Child’s T-Shirt Size:
Optional Information
**The following is optional information. There is no need to disclose if you don't want to. All information will be kept confidential. It will only be used to help us develop the program better around your child's experience of the criminal justice system.
1. Which parent and/or loved one is/was incarcerated?
2. Length of Incarcerated Parent's Sentence:
3. How long has parent been incarcerated OR how long has parent been home?
- Incarcerated
- Home
4. Is this the first or one of many incarcerations?
5. Any other info you'd like us to know about your child....

Parent Information

Children Information

First Child

Second Child

Third Child

Fourth Child

Optional Information

The Ella Foundation

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