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Project SOAR Registration Form
Please complete this form to register for the upcoming Project SOAR Program beginning April 16, 2024. Part 1 of this program operates on Tuesdays and Thursdays from 9am-3pm for 4 weeks. The second part of the program will include 4 Saturdays in the Fall. Once you complete the registration form a member of our staff will contact you with confirmation of registration. For more information call Verdun Adventure Bound at (540) 937-4920
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Success in Overcoming Adversity in Recovery
Full Name
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Date of Birth
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Gender
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Address
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Phone number
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Alternate phone number
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Email address
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Will you need transportation?
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Please list any relevant medical conditions
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Please list any allergies (food, insect stings/bites, etc.)
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Can you commit to attending at least 6 of the 8 sessions? This SOAR cohort will meet every Tuesday and Thursday for 4 weeks, from 9am-3pm, beginning April 16, 2024, through May 9, 2024.
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Other:
Emergency contact name and relationship to participant
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Emergency Contact phone number
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Emergency contact email
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How did you hear about Project SOAR?
Referral from a mental health/substance use professional
Referral from a friend, family member, or peer
Flyer or brochure
Other:
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What elements of Project SOAR most interests you? (Check all that apply)
Career development
Art Therapy
Community building
Outdoor adventure
Healthy life skills development
Nutrition
Low Ropes and High Ropes
Other:
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