Teen Intake Form: Sex Ed Online
Congratulations on taking this step to becoming more comfortable discussing your wants and needs with yourself and others. The focus we'll have here will serve you powerfully as you grow and change. And let's face it, as a human who is alive you will be bombarded with messages about how the world has various expectations of you and wants you to change.

So how do you decide what you believe? What you think? What you want? And what do you do every time any of those things shift?

The information here will help me guide the program to what you most need and want. And remember, you DO NOT need to share anything that you don't want to. Share only what you are comfortable disclosing.

The contact info you share at the end is clearly marked with THIS WILL BE SHARED WITH THE GROUP. All other answers are private and will only be seen by Julia.

PLEASE NOTE: Any grown ups you have listed on this form will be sent a link to a consent form and an FAQ page about how we'll be spending our time together. A valid consent form is required to participate. ONLY Julia will see your answers to these questions.
Email *
First and Last Name *
Preferred Name (to be used in the group) *
Preferred Name to be used with parents/guardians *
A grownup in my life can be reached at this email address (note: Julia will send a consent form and an FAQ): *
Other grownups in my life can be reached at the following email addresses (note: Julia will send a consent form and an FAQ):
Pronouns (she/her, he/him, they/them, ze/zir, etc.) *
Timezone you are in (search if uncertain, please) *
So that I know your background (select all that apply): *
What is your most pressing concern or question right now? *
What is one topic you would definitely like to discuss in our group? Feel free to use one of the options in the next question. *
Which topics are filling up your brain space the most right now? Or, what shall we chat about? *
What do you want me to know about you before we start? E.g. You will shut off your video if you become super anxious, but will still participate.
I give Julia permission to use photos or video for promotional material. I understand that all materials will be sent to me and the grown ups listed above prior to release for confirmation of said permission. *
What are the socials you'd like to share with the group?  Please list maximum 5.
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