Group Register

Group Registration Form:

You should receive a confirmation within 2-4 business days. Group may be cancelled if less that 3 people show up.

* Indicates required field

Select group *

Do you have a therapist? *

Preferred Name *

First

Last

Personal gender pronouns *

Age *

Email *

Phone Number *

Parent/ Guardians Name (If Under 18) *

First

Last

Personal Gender Pronouns of Parent/Guardian listed *

Parent/ Guardian Email (IA) *

Parent/ Guardian phone (IA) *

Can we send you reminders via *

Text Email Both Neither (we highly recommend you select one contact method)

Comment (hover cursor over ? to see instructions) *

Submit