Anxiety Management Registration
Welcome to Atlas Youth Outreach.

Atlas Youth Outreach is non-profit organization that aims to create a safe place for adolescents, ages 11-18, in Jefferson County to participate in therapeutic services that support social and emotional growth.

This registration is for an Anxiety Management Group for ages 11-13. This group is a free, six week course for teenagers to discuss their experiences with anxiety  and to learn effective methods for improving and coping with anxiety.

Groups will meet on August 1st, 8th, 15th, 22nd, 29th, and September 5th from 4:00 PM to 5:00 PM and will meet at:

Atlas Youth Outreach Office
1623 Jeffco Blvd Suite 202
Arnold, MO 63010

Transportation to and from group will need to be provided by the child's parent/guardian.

If you have questions or concerns about this form or about the group please contact us at info@atlasyouthoutreach.org or call us at 314-550-7846.
Sign in to Google to save your progress. Learn more
Email *
Demographic Information
All demographic information is collected so we may better understand the population we serve, and for reporting statistical information to the charitable grants and foundations that provide funding for our programming. Your private information will not be shared or distributed. This information will also not influence the treatment your child receives while attending our programs. 
Participant's Name *
Date of Birth *
This group is for youth ages 11-13.
Participant's Gender *
Participant's Pronouns *
Participant's Race/Ethnicity *
Email Address *
This is the email where all information for your group will be sent.
Would you like to be included in our email list to receive updates on future groups and events?
Clear selection
Parent/Guardian's Name *
What is your relationship to the participant? *
What school does the participant attend? *
Phone Number *
Address *
Who does the child live with? *
What is your annual household income? *
Is this child currently on probation with the Juvenile Office? *
How did you hear about the group you are registering for? (i.e. school, social media) *
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of Atlas Youth Outreach. Report Abuse
Google Forms