Request Form to Lead Programming//Group//Activity
If you are interested in leading a group or activity at Tyler's Redemption Place, please complete the form below. We will be in contact with you to discuss your interest in leading a meeting, program or other events/activities. Thank you!
Meeting/Group/Programming Activity Name:
*
Start Date, Time, & Frequency (weekly, monthly, one time, etc.):
*
Leader Name:
*
First Name
Last Name
Leader Phone Number:
*
Please enter a valid phone number.
Format: (000) 000-0000.
Leader Email:
*
example@example.com
Expected number of participants:
*
Type of group ( a recovery support group, AA, NA, Celebrate Recovery, Smart Recovery, a Life Skills Class, etc.)
*
Is this a closed group:
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Yes
No
Have you run this group before?:
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Yes
No
Are you in recovery:
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Yes
No
**If yes, are you a certified peer supporter?
Yes
No
Are you a family member of someone in recovery?
*
Yes
No
Do you have personal experience with addiction and/or recovery?
*
Yes
No
Is there a group co-leader?
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Yes
No
**If yes, please include co-leaders Name, Phone, and Email:
Set up needed for meetings (chairs, tables, layout, etc.):
*
Submit
Should be Empty: