Registration Form

Gender Diverse Group for Children

Name of Child(Required)

Please list your child's affirming name and pronouns (e.g. she/they).

Age of Child(Required)

Please list your child's age.

Name of Parent/Guardian(Required)

Please also share your pronouns, if you feel comfortable doing so.

Would you like to participate in the group for parents?

Yes

Email(Required)

Phone(Required)

Referral

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

Consent

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