Registration Form

Gender Diverse Adolescents & Their Guardians

Participation(Required)

Who will be participating?

Adult and Youth

Adult only

Youth only

Name of Youth(Required)

Please list your child's affirming name and pronouns (e.g. she/they). If your child is NOT participating, write "N/A"

Name of Parent/Guardian(Required)

If multiple parents wish to participate, please write both their names here. Please also share your pronouns.

Email(Required)

Consent to Email(Required)

I agree to be added to Kindred Psychology's group email list.

Selecting this box confirms your consent to be added to our email list, specific to the gender diverse groups. No identifying information is accessible or visible to others. We utilize this list as a way to send out RSVP links and other group-related notifications.

Phone(Required)

Referral

If you were referred by a provider or community member, please list their name/organization here.

Consent

I agree to the website privacy policy found in the footer of this webpage.