The Anxious Generation Book Club Registration Form

Join us for a meaningful community book club centered around The Anxious Generation by Jonathan Haidt, in partnership with Dallas City Elementary School, the Tracey Family Foundation, and Memorial Hospital. This seven-month series will meet once per month beginning in September 2026 and is designed to foster conversation, understanding, and practical insight into youth mental health and technology. Participants will receive a complimentary copy of the book, and each session will be guided by experienced educators and behavioral health professionals, creating a supportive environment for learning, discussion, and connection.

You will be notified via email of meeting dates, times and location. Most likely, there will not be a meeting in December.

Name

First NameLast Name

Email

example@example.com

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Preferred Book Language:

What school district do you reside in:

I am a

As a teacher I would like to receive CPDUs. My IEIN # is:

How did you hear about this

The Anxious Generation Book Club Participation Waiver & Media Consent

By registering for and participating in The Anxious Generation Book Club, I acknowledge and agree to the following:

I understand that this book club is an educational and discussion-based program facilitated by educators and behavioral health professionals. While general information and resources may be shared, this program does not provide individualized medical, psychological, or therapeutic advice, diagnosis, or treatment.

I voluntarily choose to participate in this program and understand that I am responsible for my own well-being during and after each session. If I have specific concerns regarding my health or mental health, I understand that I should consult with a qualified healthcare provider.

I agree to conduct myself in a respectful and appropriate manner, maintaining a supportive environment for all participants. I understand that personal information shared by others during sessions should be treated with discretion and respect.

Media Consent:
I understand that this is a public program and that photographs and/or video recordings may be taken during sessions for promotional, educational, and marketing purposes. By attending, I grant permission for my or my family member's image, likeness, and/or voice to be captured and used by the organizing partners—including Dallas City Elementary School, the Tracey Family Foundation, and Memorial Hospital and its affiliates—across print, digital, and social media platforms without compensation or further notice.

By signing below, I acknowledge that I have read, understand, and agree to the terms outlined above.

Participant Signature