GROUP
This is a form to fill out for all those interested in signing up for "GROUP – A Collective for Thinking, Feeling, Curiosity, and Play" which will begin the week of January 27th, 2020.
BASIC INFO
Name
Your answer
Gender Pronoun
Your answer
Email
Your answer
Phone
Your answer
PSYCHE STUFF
What is your experience with relational or therapeutic practices?
Your answer
Can you set and regulate interpersonal boundaries in group settings?
Your answer
Do you have the capacity to know when a situation might trigger a trauma response in you (for example: you get dissociative, or shut down, or cannot speak, etc) and do you have the capacity to sense this is going to happen before it occurs and step out of the given activity, and/or self-regulate if a trauma response does occur?
Your answer
PRACTICALITIES
GROUP meetings will occur weekly, 2 hours each session, for a core group of 5-12 members. GROUP will operate on 4-5 week cycles. At the beginning of each cycle, members will make a written commitment to show up and be together for the duration of the cycle. After each cycle members can renew their commitment for the following cycle, and new members can join as well.

The first cycle will be from Jan 27 - Feb 24
The second cycle will be from March 2 - April 3
The third cycle will be from April 20 - May 15
GROUP will take place on weekday evenings (approximately from 7-9pm). Which evenings work for you?
Please explain which neighborhoods (or subway lines) would work for you? If possible, please indicate an order of preference.
Your answer
On a scale from 1-10, please indicate how likely you are to commit to the first cycle of GROUP if the time/place of GROUP meets your aforementioned conditions.
Things are wobbly / and I have a LOT going on / It may not work out
I NEED THIS / I'M IN / and I'm willing to bend over backwards to make it work
GROUP costs $30/session. Are you in need of a low-income rate? If so, please explain.
Your answer
Any other comments or questions?
Your answer
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