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TMC Group Sign Up Sheet
Please provide your information for group sign up. Once you have completed this form, we will contact you with additional information.
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Name
*
Your answer
DOB
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MM
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DD
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YYYY
Phone number
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Your answer
Which group session are you interested in?
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Healing and Hope - Thursday's at 6 PM (Leanora)
Healing and Hope - Saturday's at 10am (Tiffani)
It Takes Two - Building Healthy Interpersonal Relationships - Wednesdays at 6pm (Leanora & Teleshia)
It Takes Two - Building Healthy Interpersonal Relationships - Saturdays at 1pm (Leanora & Teleshia)
New Year, New Me - Teen Edition (Ages 13-17) Saturday's at 11am (Sarah)
New Year, New Me ADULT - Saturdays at 12pm (Sarah & Teleshia)
New Year, New Me ADULT - Monday's at 6pm (Sarah & Teleshia)
Required
Can you commit to joining for 6 weeks?
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Yes
No
Maybe
By saying yes, you understand that the $20 is nonrefundable.
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Option 1
Type name below for agreement
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Your answer
Todays Date
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YYYY
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