NEW Rise Up Group Therapy Form

Rise Up: Transforming Anxiety for Teens

Complete form below to signup and a representative from Vantage Community Services will contact you within 48 hours. Payment will be through PayPal to complete registration. Please call 403-340-8995 if you would prefer to pay over the phone.
Registrant Information
Name

First Name Last Name
E-mail
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He/Him She/Her They/Them Other
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Phone Number

Area Code Phone Number
Cell Phone

Area Code Phone Number
Participant Information
Name

First Name Last Name
D.O.B

Month Day Year
Date
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He/Him She/Her They/Them Other
How did you hear about the workshop?

Social Media Friend/Colleague School Pamphlet Website
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CAD Rise Up Group Therapy (1 Day)

Pay with PayPal

Please click one of the PayPal options to complete payment and submit the form.

Rise Up: Transforming Anxiety for Teens