Art of Resilience Interest Form

Art of Resilience Interest Form

Use this form to express interest in the Art of Resilience Somatic Art Therapy Group and help us determine the best schedule!
This form is intended to be filled out by the Guardian of the future participant.

You will be contacted if we have any follow-up questions, or once enough interested participants are determined, via the provided Guardian Contact Information.

Please note, this group is offered in-person in Linthicum, MD. It's the responsibility of the Guardian to ensure the participant has transportation to and from group, the ability to be on time, and the ability to attend the full 90-minute sessions.

Due to the content, this group is considered a therapeutic group. However, NAT20 LLC currently doesn't accept insurance, but they do participate in the Reimbursify program. Please see www.nat20therapy.com Client Portal page for more information.
Participant Information
Name*

First NameLast Name
Age*
Pronouns
What are the goals for your teen in participating in Art of Resilience?*
Please select the days/times you're teen would be able to participate. Select all that apply.*
Guardian Contact Information
Name*

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

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
By submitting this form, you express interest in the Art of Resilience Somatic Art Therapy Group for the participant listed.
Text Signature of Guardian (First and Last Name)
Upon submission, you will be directed to the Nerd Adventure Therapy 20 LLC website for any questions you may have about the practice.
Should be Empty:

Art of Resilience Interest Form

Participant Information

Guardian Contact Information