Help For Christian Troubled Teens Challenge Christian Bootcamp Christian Treatment Christian Rehab Does Your Teen Challenge Authority

A life coach is standing by waiting to speak to you, but first we require some pertinent information from you. Please fill out this form entirely so that you can speak to a coach immediately.

* = required field

CONTACT PERSON(s)

First Name *

Last Name *

Spouse *

COMMUNICATION

Email *

Cell Phone *

Home Phone

Work Phone

Website

ADDRESS

Street *

City *

State *

Zip *

Province

Country *

INTERNET REFERRAL

Search Engine *

Search Key Words *

OTHER REFERRAL

Referred by *

Describe Referral

TROUBLED LOVED ONE

Student’s Full Name

Birthdate *
 

Social Network URL (eg. Myspace, facebook, etc.)

Describe Problem *

OTHER INFORMATION

Church Affiliation *

Housing Need

   
   
   

Program Interest

     
     
     
     

Desired Term of Enrollment

Second Chance Contact Form
Second Chance * Administration/Accounting 13835 N. Tatum Blvd. # 164 * Phoenix, AZ * USA * 85032 *
Second Chance - Does Your Teen Challenge Authority?  Contact us for Christian Education, Alternative Boarding Schools, Therapeutic Spiritual Treatment.  Call today to get Help for Troubled Teens Diagnosed with ADD, ADHD, School Problems, Suicidal Tendencies, Depression, Bi-polar Disorder, Rebellion or Substance Abuse. Copyright ©  2005 – 2007
Troubled Teens Program –  Christian Troubled Teen and Kids – Help For Troubled Teens – Christian Boarding School – Boot Camps – Wilderness Programs Alternatives - Teen Problems - Problem Teens