A Group For Girls
TREAT your Mind Kind.Thrive in this 8-week group for girls.Being mindful when listening and participating; interacting with one another in a polite and respectful manner; gaining confidence in the group setting; understanding of the lessons and vocalize that understanding. .
Start/End Dates: May 6th - June 24th
Start and End Times: 4:00-5:00
Name of parent or guardian
First Name
Last Name
Participant's Name
First Name
Last Name
Participant's Date of Birth
-
Month
-
Day
Year
Date
What age group are you signing up for?
Ages 8-12
Ages 12-15
Is participant currently a WSCC client
Yes
No
If yes, who is the participant's current clinician?
Email
example@example.com
Phone Number
-
Area Code
Phone Number
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Insurance?
Private
Medicaid
None
None, but interested in learning about sliding scale program
If you have insurance, please provide carrier name, group and/or ID number
How did you hear about this group?
Social Media (Facebook, Instagram, LinkedIn, Twitter)
Enewsletter/Eblast from WSCC
Word of Mouth
Online Ad
WSSC Counselor
Other
Questions/Comments
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