Holding Space
Welcome! We’re so glad you’re here. Please complete this form to register for our group. Note: To ensure the group is a great fit and to answer any questions you might have, final registration is contingent upon a quick, 15-minute screening call before the first group session. We will gather once a week for one hour, starting the week of June 8th and wrapping up the week of July 27th.
Which group session would you like to attend?
*
Monday, 6:00-7:00 PM
Tuesday, 5:00-6:00 PM
Full name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Preferred Method of Contact
Phone
Email
Date of birth
*
-
Month
-
Day
Year
Date
Referral source (if applicable)
Register
Should be Empty: