Group Contact Information | counselingwithkc

Therapeutic Dungeons and Dragons Group
Registration Form

First name

Last name

Pronouns

Caregiver Name

Phone

Fee for the full 9 week D&D session is $475 and will be billed the Monday of the group's first meeting

If requesting financial support, please choose from the options below:

10%

25%

50%

None

I acknowledge by checking this box that by signing up for this group I am reserving one of 5 available spots. Late cancellation of registration, 24hrs before the first group, will result in a non-refundable $150 fee which will be charged at time of cancellation.

I acknowledge that this group does not replace or provide crisis level of care. For higher level of care needs, I will outreach to my local crisis supports as needed.

Thanks for registering! You will receive an email or phone call within 3-5 days to set up a brief consult regarding further details around group fit and billing. For further questions, please contact Kc at counselingwithkc@gmail.com

Therapeutic Dungeons and Dragons Group Registration Form

Therapeutic Dungeons and Dragons Group
Registration Form