See Our Mission First Here The Human Lens Project

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See Our Mission First Here The Human Lens Project — Registration & Waitlist Form

Welcome — we’re glad you’re here.
The Human Lens Project offers free, trauma-informed community spaces for adults, teens, and survivors who want connection, clarity, confidence, or healing.

This form helps us:
• understand which program(s) you’re interested in
• notify you of upcoming session dates
• reserve your seat
• send reminders and updates
• create safe, confidential spaces

Your information is private, never shared, and used only for program communication.

Thank you for taking the first step. You belong here.

Full Name *

Email Address *

Phone Number *

Which Program(s) Are You Interested In?

The Naked Room (Adult emotional support + connection circle)

Rebuilding HER (Breast cancer survivor support + free 3D areola restoration)

Becoming HER (Teen/young women identity + confidence program)

Allowing HIM (For men who’ve carried the weight alone)

What brings you here? (Optional)

(Share as much or as little as you want.)

How would you like to receive updates?

Text

Both

Clear selection

Consent + Confidentiality Agreement (all must be selected):
*

I understand The Human Lens Project provides free community support spaces and is not a substitute for therapy or medical care.

I consent to being contacted about the program(s) I selected.

I understand my information will remain private and confidential.

Required

Submit

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