THRIVE

THRIVE

Teen Process Group
EVERY WEDNESDAY, 5:30-7:00 PM

THRIVE is an ongoing process group at KCC run by Genevieve Stafford. This group offers teens mutual support, self-awareness, interpersonal skills, and identity development. Teens age 13-18 are welcome.
Name of teen*

First NameLast Name
Preferred Pronouns
Are you a former or current KCC client?*

YesNo
Client Date of Birth*

MonthDayYear
Date
Client Email*
example@example.com
Client Phone Number*
Please enter a valid phone number.
Parent/Guardian Name*

First NameLast Name
Parent/Guardian Email*
example@example.com
Parent/Guardian Phone Number*
Please enter a valid phone number.

In order to join THRIVE, you must attend an orientation session with our group leader. You may be required to pull your teen out of school depending on availability. Please SELECT all times you would be available to schedule this meeting:?*

	10 AM	11 AM	12 PM	2 PM	3 PM	4 PM	5 PM
Monday
Tuesday
Wednesday
Thursday

Is there anyone your teen would be uncomfortable being in group with? Please provide their name(s).
Is there anything you want our group leaders to know before the first group session?
Contact Genevieve Stafford, our Group Coordinator, with any questions.

Genevieve@kernersvillecounseling.com

336-283-3830
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