Registration Form

Gender Diverse Adolescents & Their Guardians

Participation(Required)

Who is 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)

Phone

Referral(Required)

How did you find out about the group?

Name

This field is for validation purposes and should be left unchanged.