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Intake Form

Reach One & Teach One Anger Management Intake Form

Full Name*

Date of Birth*

Phone Number*

Email Address*

Home Address*

Are you court-ordered? (Yes/No)*

Court Name (e.g., Riverside County Court)*

Case Number*

Probation Officer Name

Next Court Date*

Program Length Needed: (15 Weeks | 26 Weeks | 52 Weeks | Not Sure)*

Preferred Class Days/Times*

I certify that the information provided is accurate and understand this is a court-related program.

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Reach One & Teach One offers court-approved Anger Management classes designed to help individuals develop healthy coping skills, improve emotional regulation, and successfully meet court requirements. Our programs range from 15 to 52 weeks, providing structured support for long-term growth and accountability.

Fees :

$75 one-time registration/intake fee
$35 weekly class fee

How to Get Started:

Complete the online registration form with your personal and court information (case number required).
Submit your $75 registration fee to secure your enrollment.
You will be contacted with your class schedule and start date.
Attend weekly sessions and submit your $35 payment prior to each class.

Our program is designed to be supportive, structured, and focused on helping you build better decision-making skills, manage conflict, and create positive change.

Registration fee weekly fee

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