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D&D 101 - Teen Group
Hosted by A New Hope Therapy Center. Please take a few moments to complete the sections below. Your answers will be kept confidential, and will help us determine if this group is what you are seeking.
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Email
*
Your email
First & Last Name
*
Your answer
Preferred Name
*
Your answer
Preferred Pronouns
*
she/her/hers
he/him/his
they/them/theirs
Parent/Guardian Name
*
Your answer
Phone Number
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
How do you feel about working in group settings?
*
Your answer
Describe any challenges you may have concerning social situations.
Your answer
How would you rate your current level of self esteem?
Very Poor
1
2
3
4
5
Very Good
Clear selection
While it is not a requirement, what is your current level of experience with table-top gaming?
Never Played
1
2
3
4
5
Very Experienced
Clear selection
Are you currently participating in mental health therapy (e.g., individual, couple, family)?
*
Yes
No
Please include any additional information about yourself that you feel that the facilitators of the group should know about you.
*
Your answer
Group Dates & Times (Wednesdays 4:00pm-5:30pm beginning July 7th)
NOTE: Please contact our A New Hope Therapy Center receptionist, Courtney Chadwick, by email (
courtney@anewhopetc.org
) to obtain and complete your online group intake forms. The completion of these forms is required before you can join our group.
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