Teen Talk March 2023 Registration Form

Please respond to the questions below to complete your registration for Teen Talk March 2023 Workshop.

This information is confidential and will only be viewed by the Clinical Coordinator and Workshop Facilitator. You may be contacted by the Clinical Coordinator to follow-up on your responses.

Workshop Schedule: Thursdays 6-7pm. March 2, 9, 16, 23, 30, April 6.

If you have any questions, please contact Kristy Harrington, Clinical Coordinator, at kharrington15@partners.org

Thank you!

Teen's First Name

* must provide value

Teen's Last Name

* must provide value

Teen's Age

* must provide value

Teen's Email - Optional (in order to receive directions, reminders and post-workshop follow-up)

Parent First Name

* must provide value

Parent Last Name

* must provide value

Parent Phone Number

* must provide value

Parent Email (to receive directions, reminders, and post-workshop follow-up)

* must provide value

This is a voluntary, educational workshop. We find that the teens who get the most out of our workshops are those who have been given information about it and voluntarily agree to participate. Has your teen been given information about the workshop and agreed to participate?

* must provide value

What does your teen hope to get out of this workshop? In other words, why does your teen want to participate in this workshop?

* must provide value

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With this being an educational, supportive workshop and not a clinical therapy group, our facilitators are unable to offer individualized, therapeutic support. What other supports does your teen have right now - formal or informal? (for example, a therapist, a mentor, or other trusted adult who teen feels supported by)

* must provide value

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What might get in the way of your teen being able to participate in the full six week series?

* must provide value

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This is an in-person workshop, held at Salem Hospital. Masks are still required in the hospital setting. There is no virtual option for this workshop. Is your teen able to attend in person, and agree to wear a mask for the duration of the workshop?

* must provide value

Is there anything else you would like us to know about your teen?

* must provide value

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