Adolescent Stress Registration

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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 our Adolescent Stress Group for ages 11-18. This group is a free, ongoing, monthly meeting for teenagers to find peer support on common stressors in their lives. Discussions will be based off what teens in the group are bringing to each meeting. The meetings will be lead by 2 licensed mental health professionals, who will offer guidance and therapeutic interventions as well.

Since the group will meet every month you will only need to register your child once. You will then only need to RSVP to each month's meeting after that. Attendance each month is not required! Teens may come to group when they feel they are in need, when they want to support others, or as they see the group fitting their needs.

Groups will meet on the 3rd Monday of every month from 4:00 PM to 5:30 PM and will meet at:

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

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.ter your child once. You will then only need to RSVP to each month's meeting after that. Attendance each month is not required! Teens may come to group when they feel they are in need, when they want to support others, or as they see the group fitting their needs.

Groups will meet on the 3rd Monday of every month from 4:00 PM to 5:30 PM and will meet at:

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

Meeting dates are tentatively set for January 15th, February 19th, March 18th, April 15th, May 20th, June 17th, July 15th, August 19th, September 16th, October 21st, November 18th and December 16th. These dates are subject to change!

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.

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?

Yes

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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? *

Yes

How did you hear about the group you are registering for? (i.e. school, social media) *

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