Tewa Roots Society Program Request Form

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Tewa Roots Society offers prescriptive, therapeutic programming for groups. We are not a recreation program. Rather, we use recreational activities as a tool for therapy and therapeutic outcomes. We primarily work with tribal entities, substance abuse programs, mental health programs, youth prevention programs, schools, and organizations that serve Indigenous populations.

To request a Therapeutic Adventure Program please fill out the form below. Please submit program request form at least one month in advance. Once the form is received we will discuss your request as a staff. You will receive a response within 7 business days.

Email *

First and last name *

Organization *

Email address *

Phone number *

Location of where therapeutic adventure program is requested to be held *

Requested date

(Please submit program requests at least one month in advance to allow for proper scheduling and planning.)

YYYY

Alternate request date *

YYYY

Select program request type: *

One time program

Ongoing Programming

Length of program needed in hours and minutes *

Expected number of attendees *

Specify desired outcome:

Please explain clearly what you are requesting. Who is the target audience? What are your goals for the time together? What do you hope the group gains from the experience?

Please list any group accessibility needs: *

Submit

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