Parent Interest, Readiness, and Fit Survey

Child check-ins

If you have not completed the child check-in(s) yet, return to the Home Version page and complete Step 1 for each child first. Then come back here for Step 2.

The Ticket Program is a structured behavior framework designed to support consistency, clear expectations, and follow-through. This check-in helps us understand your goals and determine the best next steps for your family.

Submitting this form does not automatically grant access. Approval helps protect the integrity of the program and ensures families receive the right setup and support. In most cases, you will receive next steps within 24 hours.

Parent / Guardian Information

1. Parent or Guardian Full Name 2. Email Address 3. Phone Number

Numbers only are best. The system will remove symbols automatically.

Home City Home State Home ZIP Code 4. Can this phone number receive text messages?

Yes No (landline or no texting)

5. Preferred Method of Communication

Text Message Email Both

Understanding Why You Are Here

6. Which best describes your interest in The Ticket Program?

I want to actively use the program at home I am exploring options and want to learn more My child’s school or teacher recommended this program

7. If approved, how do you plan to use The Ticket Program?

Home use only Home use with optional teacher integration Not sure yet

Have you used, or are you currently using, any version of The Ticket Program?

Sample Scenarios

Please read each scenario carefully and select the response closest to what you would most likely do.

8. Rewards Scenario

Your child earns Tickets consistently over several days and qualifies for a reward they want.

Rewards should be earned and not given automatically I would give the reward even if expectations were not fully met Rewards should be immediate and flexible I am unsure how rewards should work

9. Chores & Responsibility Scenario

Your child does not complete assigned chores but asks for screen time anyway.

Deny the reward and explain why Allow the reward this time but address it later Negotiate a compromise Give the reward to avoid conflict

10. Consequences Scenario

Your child repeatedly ignores expectations after being reminded.

Consequences should be consistent and predictable Consequences depend on the situation I avoid consequences when possible I am looking for a better system

Family Context & Needs

11. What prompted you to explore a structured behavior system? 12. What behaviors or challenges are you currently experiencing with your child(ren)? 13. What have you already tried that worked? 14. What have you already tried that has not worked?

Program Expectations (Check box to accept)

15. I understand that The Ticket Program requires consistent adult follow-through. 16. I understand that approval is required before access is granted.

Text Messaging Consent

I consent to receive real-time text messages related to The Ticket Program (required only if I select Text or Both above).

If you selected Email only, or if your phone cannot receive texts, you can leave this unchecked.

Demo Interest (Optional)

If approved, would you like access to a limited demo of The Ticket Program?

Yes No

If yes, what are you hoping to see or learn from the demo?

Optional: Child Readiness Snapshot

After I submit this parent survey, show me a quick readiness snapshot for each child check-in I entered.

This snapshot is not a diagnosis and it is not a guarantee. It is a simple interpretation of the child check-in to help you start strong. If you do not request it now, it can be offered later after purchase.

I certify that the information provided is accurate and that I understand the expectations of The Ticket Program.