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
*
First Name
Last Name
Participant Birthdate (if under the age of 13, please email us first)
*
-
Month
-
Day
Year
Date Picker Icon
Participant's Phone Number, if applicable
Participant's E-mail, if applicable
Confirmation Email
example@example.com
Parent/Guardian Full Name
*
First Name
Last Name
Parent/Guardian Phone Number
*
Parent/Guardian E-mail
*
Confirmation Email
example@example.com
Can you receive texts on this phone number?
*
Yes
No
Please describe why you are seeking these services for the participant:
*
Parental/Guardian Consent
Download and return parental/guardian consent to support@sherecovery.com.
Hover over and click the down arrow on the right to download form to sign/email.
Payment Information
Select Preferred Payment Plan
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Weekly Payment Plan
$25 due today, then $25 per week for 11 weeks starting October 2, 2023.
$
25.00
Monthly Payment Plan
$100 due today, then $100 per month on October 23, 2023 and November 20, 2023
$
100.00
Pay in Full
Payment due in full now.
$
300.00
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Submit
Should be Empty: