Separation & Divorce Support Groups for Kids: Interest Form

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Thank you for your interest our separation and divorce groups! If you would like to learn more our groups and get on our list to hear about upcoming groups, please take a moment to fill out the following form. Our groups normally run for 6-8 weeks.

Name of Child (first and last) *

Child's Date of Birth *

YYYY

Child's Grade

Your Name *

Email *

Phone Number *

Do you prefer to be contacted by phone or email?

Phone

Either

Please indicate your child's availability for one of our groups *

3pm

4pm

5pm

6pm

7pm

Monday

Tuesday

Wednesday

Thursday

How did you hear about this group? *

Submit

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