Charlie Health Alumni Discord Interest Form
Hello Charlie Health Alumni! Please read this in its' entirety prior to filling out the form!

This Discord form is only intended for individuals who have been fully graduated and discharged from Charlie Health. Please wait until you are discharged to sign up for Alumni Discord. We can't wait to have you join! 

We have servers for 15-17 year olds and one for young adults (18+) 

New to Discord? Totally ok! If you do not have a user name for Discord please sign up for Discord, create a user name and then fill out this form. 

By joining you will not only have channels focused on daily overall wellness and support related to their overall mental health journey, but this will also be the spot for you to get connected to weekly alumni events. We will be continuing to build and grow opportunities for you to continue your connection with Charlie Health and stay up to date with offerings.

Please complete the following and you will receive the link to Discord in your email.The link to join Discord will expire after seven days.

Please know we will only use your contact information if we believe you are in crisis or in an unsafe situation. However, Discord and this form will not be monitored 24/7. Participating in the Charlie Health alumni is 100% optional. You can choose to attend events, participate in Discord, both or none. You can take breaks and come back whenever needed/wanted. Please know you can leave the server at any time.

If you would like to join again at a later date, simply email alumni@charliehealth.com and we will get you reconnected. See you there!

Sign in to Google to save your progress. Learn more
Name: 

Include your first and last name that would be connected with Charlie Health.
 *
I confirm that I have been discharged from Charlie Health and am an Alumni.  *
Required
Email:

This is where we will send the Discord Server link.
 *
How old are you? *
Discord Username:

Include your full username. If you do not have a username for Discord please sign up for Discord, create a username and then fill out this form.

You must have a valid Discord username before receiving a link to join
 *
Discord ID: To find your Discord ID, right-click on your profile picture in the Discord app, then select "Copy ID" from the menu; this will copy their unique Discord ID to your clipboard which you can then paste here *
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Charlie Health.

Does this form look suspicious? Report

Google Forms