Healing and Loss: A Group to (Ages 14-18) 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 Healing and Loss for teens between 14 and 18 years old. This group is a free, eight week course for teenagers to process the emotions they may be feeling around grief. Teenagers who have experienced any loss that is emotionally impacting them may join to better understand how grief works, how to experience grief in a healthy way, and meet other teens experiencing loss and grief. 

Groups will meet on July 24th, 31st, August 7th, 14th, 21st, 28th, September 4th and 11th from 4:30 PM to 5:30 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.
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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 *
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. Important: Please provide an email address that will be able to receive emails from outside sources. School and work addresses sometimes have safeguards that prevent our emails from reaching you. As a result you may miss reminders and important information regarding the group. 
Would you like to be included in our email list to receive updates on future groups and events?
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Parent/Guardian's Name *
What is your relationship to the participant? *
What school does the participant attend? *
Phone Number *
Address (Include Zip Code) *
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) *
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