Teen Talks
A Support Group for Teens
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Name
This is for the name of the teen applying for the group
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Are you 18 years or younger?
Parent/guardian name
If older than 18 OR if you don't need parent/guardian permission, disregard this question
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Parent/guardian Phone Number
If no parent/guardian needed, please provide the teen applicant's phone number
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Parent/Guardian Email
If no parent/guardian needed, please provide the teen applicant's email
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Preferred Method of Contact
This is for both parents/guardians and teen applicants, if teen is older than 18
One-on-one sessions are also available; is this something you would prefer or would you want to go through with the group session?
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