Group Interest Form

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Group Interest Form

Join Navigating Courage Counseling & Consultation for our next group cohort.
This group provides a safe, supportive space to connect, reflect, and recharge during whatever season you're in. By completing this form, you are expressing interest to be apart of a group dynamic to learn, share, and receive in a confidential, supportive enviornment. Our Group facilitator will be in touch with you to discuss more details.

SECTION 1 – Contact Information

Full Name *

Phone Number *

Email Address *

Age *

SECTION 2 – Group Interest

What interests you about joining this group? *

Have you attended therapy or a support group before? *

Yes

Prefer not to say

How did you hear about this group? *

SECTION 3- Payment

The group has a “Pay What You Can” holiday price between $30 – $50. How much do you plan to contribute? *

Invoice will be sent prior to each group; do you agree to pay prior to attending group? *

If you choose to pay in full for all groups in advance, please contact us.

admin@navigatingcouragecac.com

Yes

SECTION 4 – Consent & Agreement

Please review and check each box before submitting.

This group is for personal growth and peer support, not a substitute for individual therapy.

Checkboxes (required): *

I understand that group participation is confidential and agree to respect others’ privacy.

I consent to be contacted by Navigating Courage Counseling & Consultation regarding group details.

I understand that registration is not complete until payment is received.

Required

Submit

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