Unplowed Ground Family Intensive Application

Unplowed Ground Family Intensive Application

MM slash DD slash YYYY
Name of Primary Caregiver(Required)
Address(Required)

If married...

Spouse's Name

Child's Information

Name(Required)
This field is hidden when viewing the form
Child is(Required)
MM slash DD slash YYYY
Please list name, age, and if you plan to implement Unplowed Ground with them as well. (include everyone you plan to bring with you for the Intensive)
If yes, explain.

Symptoms of Compromised Attachment

Please rate each according to your child- Strongly Disagree meaning does not exhibit this behavior, Strongly Agree meaning often exhibits this behavior.
Superficially Charming(Required)
Lack of Eye Contact(Required)
Indiscrimately affectionate with strangers(Required)
Not affectionate on parents' terms(Required)
Destructive to themselves, others, or material things(Required)
Excessively controlling of small children or animals(Required)
Lying about the obvious(Required)
Stealing(Required)
No impulse control(Required)
Lack of conscience(Required)
Abnormal eating patterns(Required)
Poor peer relationships(Required)
Preoccupation with fire, blood, or gore(Required)
Preoccupations with bodily functions(Required)
Persistent nonsense questions and chatter(Required)
Non-stop demanding of attention(Required)
Triangulation of adults(Required)
Triangulation of adults(Required)
False allegations of abuse(Required)
Creating chaos(Required)
Type First and Last Name

Intensive Pricing

Unplowed Ground Family Intensives cost $3500. A non-refundable deposit is due upon approval to schedule and secure dates for the intensive. If approved, You will be contacted by our Office Manager (hannah@kingsranch.net) regarding payment.