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Prism
Registration for the Fall 2024 Sessions will begin August 1st!
Prism Registration Form
Your Information
Complete Legal Name
Required
Address
Phone Number
Required
Marital Status
** None
Married
Single
Separated
Divorced
Remarried
Widowed
Other
Your Children (Name / Age / In Rainbows?)
Email Address
Required
Loss Information
What are the losses you would like help with?
When did the losses occur?
How have your losses affected you?
Have you been in counseling and/or therapy? *
** None
Yes
No
If "Yes", have you informed your counselor/therapist that you are registering in this Prism group?
** None
Yes
No
Confidentiality
I promise not to disclose anything shared in this support group.
I Agree
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