Bears Care Crisis Support Form

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At Gray's Creek, we want you to know that you are not alone! This form has been created for students in crisis, meaning there is a serious issue or concern that needs to be addressed. If at all possible, students should reach out to parents or guardians first; however, we at Gray's Creek will assist students at any stage of a crisis within legal and responsible parameters.
* In most situations, we will eventually or immediately have to inform other qualified adults about sensitive information or circumstances. This is only to provide the best support and protection for you and all involved. Items with the * beside them are mandatory. The others can be skipped, but we prefer that they are answered when necessary.

Email *

Vanessa Wade *

Contact information (this can be phone number, social media platform name, etc.) *

Nature of Crisis *

Self-harm/ Suicide

Violent Thoughts

Extreme Anxiety or Depression (outside of what is normal for you)

Eating disorder

Someone you know is going through one of the above

You are in immediate danger/harm

Other:

How soon do you need assistance? *

Right Now

Within 12-24 hours

Within the time span of a week

If you can, please give us more details about your selected "Nature of Crisis".

Please provide your location if possible, any details that can help someone find you if necessary.

Is there anyone we can contact for you to get more helpful information? A person we can help you locate? Please provide the person's first and last name and number (even if they are not picking up the phone at this time).

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