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Registration Form
Gender Diverse Group - Adults
Affirming Name
(Required)
First
Last
Age
Pronouns
(Required)
What pronouns do you currently feel most comfortable using?
she/her
he/him
they/them
she/they
he/they
other/not listed
Email
(Required)
Please list an active email address that you are able to regularly check. All registrations will receive a confirmation via email within 48 hours.
Consent to Email
(Required)
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.
I agree to be added to Kindred Psychology's group email list.
Phone
(Required)
Do we have permission to leave a voice message?
(Required)
Yes
No
Referral
If you were referred by another provider or community member, please list their name/organization here.
Consent
(Required)
I agree to the website privacy policy found in the footer of this webpage.
