EmpowerHER: A 5-Day Expressive Arts Therapy Group for Teen Girls
Please fill out the form below to indicate your interest in one, or both, of our Expressive Arts Weeks for Girls. Filling out this form does not commit you to a group. Once received, someone from Renewed Counseling & Play Therapy will reach out to you to answer any questions you have and provide next steps.
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Name of Child: *
Child's Birthday *
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DD
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YYYY
What week(s) would you like to attend (check all that apply)? *
Required
Parent/Guardian 1 Name:  *
Parent/Guardian 1 Phone Number *
Parent/Guardian 1 Email:  *
Parent/Guardian 1 Preferred Method of Communication (check all that apply):  *
Required
Parent/Guardian 2 Name: 
Parent/Guardian 2 Phone Number: 
Parent/Guardian 2 Email:
Optional: Use the space below to share questions you have about the group, or to write anything you would like to share with us. 
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