Teen and Tween Support Group/Workshop Registration Form

Please complete and submit the form below. Be sure to choose the group or workshop you’re registering for.

Name (Participant)

First Name

Last Name

Pronouns

Date of Birth

Grade (2022-2023)

Select Group/Workshop

Name (Parent/Guardian)

First Name

Last Name

Name (Parent/Guardian)

First Name

Last Name

Phone

(###)

###

####

Email

Address

Please provide your mailing address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Please provide us with any information you would like us to know about your child