H.E.A.L Wellness Program Interest Form

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All information collected from this form will be kept confidential.

Thank you for your interest in Narika's HEAL Wellness Program! Under the HEAL initiative, Narika aims to create safe spaces for healing by offering wellness and life skill workshops designed to foster holistic self-care and well-rounded growth.

Please fill out this form if you are interested in participating. We will reach out when we have new sessions coming up!

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E-post *

Confirm Email: *

Name: *

Phone Number: *

How did you hear about Narika? *

Friend/family member

Internet

Another organization

Social Media

Email list

Övrigt:

Obligatorisk

City of Residence: *

Are you from Livermore/Pleasanton/Dublin CA? (This will not affect your placement in this program and is purely for data recording purposes) *

Yes

Are you from Fremont CA? (This will not affect your placement in this program and is purely for data recording purposes) *

Yes

Which sessions are you interested in attending?

June 16 (6:30-7:30 PM) - Managing Stress Mindfully

July 28 (6:30-8:00 PM) - Journaling Workshop

Sept 8 (6:30-8:00 PM) - Caring for My Body

Oct 20 (6:30-8:00 PM) - Dance and Movement

Nov 23 (6:30-8:00) - Lights and Colors

Dec 20 (6:30-8:00) - Holiday Gathering

Do you identify as a domestic violence or sexual assault survivor? (All are welcome to join our HEAL sessions regardless of your answer here).

Yes

Decline to share

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I am also interested in:

Domestic Violence Case Management Services

Domestic Violence Support Groups

Job Training & Financial Literacy Program

Individual Therapy

Domestic Violence Advocate Trainings

Anything else you'd like to share that you think we should know? (EG- your availability, accessibility, subjects you would like to learn, etc)

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