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Student Group Sign-up
We are excited about the opportunity to walk with you as you learn more about yourself and make academic choices that align with who you are as an individual. If you would like to inquire further about the group being offered, email Megan at MeganS@khesedwellness.com.

We are happy to talk with you to make sure the group is the right fit for you! Visit www.KhesedWellness.com to learn more about Khesed. We look forward to working with you!

Student's Name *
Your answer
Student's School *
Your answer
When are you available to have the initial consult? Please mark all that apply
Morning
Afternoon
Evening
Monday
Tuesday
Wednesday
Thursday
Parent/Guardian Name and Relationship *
Your answer
Parent/Guardian Phone Number *
Your answer
Any allergies or medical health issues we should be aware of? *
Emergency Contact Information *
We will be taking into consideration your academic history. Do you have access to your standardized tests, AP/IB test scores, and transcripts? *
Do you have access to a laptop/laptop alternative that you can bring to group? *
How will you be paying? *
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