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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?