Teen Mindfulness Group Registration

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Parent First and Last Name *

Email *

Teen First and Last Name *

Teen Age and Grade *

What draws you to joining this group at this time? What do you hope (or hope your teen) will gain from this group? *

Do you have any questions about the group? *

Do your teen have any special needs related to accessibility or ability to participate in the group? We hope to make the group as inclusive and accessible as possible. (For example, learning disabilities, language or auditory processing physical disabilities etc.) *

This group is not a form of mental health treatment or psychotherapy services. This group does not replace other forms of psychotherapy or medication management. By marking yes you understand this is not a psychotherapy service or therapeutic treatment intervention, but an educational and skill building mindfulness group. *

Yes

I do not understand.

What are times of day/days of the week that your teen is available for a 15 min screener call? *

Thank you for filling out this form. Our intake coordinate will be in touch within 24 hours with next steps for registration!

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