SheRecovery Teen Girls Recovery Group
Mondays starting September 25, 2023 at 7:00pm CDT. For GIRLS aged 12-17 only. Consent from Parent/Guardian/Participant is required. Enroll by September 19, 2023.
Participant's Full Name
Participant Birthdate (if under the age of 13, please email us first)
Date Picker Icon
Participant's Phone Number, if applicable
Participant's E-mail, if applicable
Parent/Guardian Full Name
Parent/Guardian Phone Number
Can you receive texts on this phone number?
Please describe why you are seeking these services for the participant:
Download and return parental/guardian consent to firstname.lastname@example.org.
Hover over and click the down arrow on the right to download form to sign/email.
Select Preferred Payment Plan
( X )
Weekly Payment Plan
$25 due today, then $25 per week for 11 weeks starting October 2, 2023.
Monthly Payment Plan
$100 due today, then $100 per month on October 23, 2023 and November 20, 2023
Pay in Full
Payment due in full now.
Credit Card Details
Credit Card Number
Should be Empty: