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Building Brotherhood Group Registration
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* Indicates required question
Email
*
Your email
Name
*
Your answer
Age
*
Your answer
Phone Number
*
Your answer
Who referred you to
Building Brotherhood
Men's group?
*
Growing with the Seasons
A friend
Social media
Other:
Are you willing to meet in person for groups & activities?
*
Yes
No
Yes, but it needs to be close enough to where I live
Other:
Required
Is it okay for Growing with the Seasons to share updates with you about
Building Brotherhood
as well as other programs or events by email?
Yes, that's fine
No
Clear selection
What is your availability in January to attend an in-person activity (hike, community dinner, game night)?
1/14/23
1/15/23
1/21/23
1/22/23 (same day as group meeting)
Are you currently receiving any mental health treatment?
*
Yes
No
Other:
Required
Please shared any goals or intentions you have for your participation in Building Brotherhood
*
Your answer
What is something you'd like to discuss or share in our group that has been difficult to face or be honest about? (ex. struggles with addiction, struggles in relationships)
Your answer
Please describe 1-2 of your closest relationships:
Your answer
Which date do you plan to attend
*
2/19/23
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