Sanctuary Sixteen Waitlist & Application
Waitlist opens up February 1st.
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
How old is your teen?
What is your relationship to the teen?
Their parent
Their legal guardian
Their grandparent
Their therapist or counselor
Other
Check off all the areas of focus that your teen would benefit from working on.
*
Confidence building & self-esteem
Emotional understanding
Identity exploration & self discovery
Creative expression
Healthy friendships & boundaries
Stress management & coping skills
Social pressure & comparison
Perfectionism & fear of failure
Body Image & self- kindness
Spiritual curiosity or intuitive development
Sensory awareness/Body mind connection
Being a highly sensitive person or empathetic
Feeling "different" or misunderstood
Goal setting & motivation
Shadow work for teens (gentle, age approrpriate)
Safe and regulated community with connection with peers
Journaling or introspective work
Other
What makes your teen magical, unique, or special?
*
What challenges have they been facing lately?
What type of environment do they thrive in?
Does your teen currently have a therapist or counselor? (Sharing this information is optional.)
Yes
Yes, and I would like you to pass their action plans along to their therapist.
Not currently, but they have in the past.
No, my teen has not attended therapy.
I'd prefer not to answer. (Totally acceptable)
Sanctuary Sixteen is supportive but not a replacement for clinical mental health care.
I understand
I understand that Sanctuary Sixteen is a personal growth and creative-expression community, not therapy. If accepted, I consent to my teen participating in discussions, activities, and guided emotional tools.
I agree.
When our waitlist opens up, how do you prefer to be notified on acceptance?
Email
Text
Phone Call
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