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Worksheet

Dandelion Teen Girls Group Application

Thank you for your interest in Dandelion Teen Girls Empowerment Group!

Your complete and honest answers are very helpful so we can make sure this group is the right fit. 

1. ➜

Parent's First & Last Name

2. ➜

What is the best way to reach you (please provide email or phone number)?

3. ➜

Child's First & Last Name

4. ➜

Child's Date of Birth

5. ➜

How did you hear about this group?

6. ➜

What do you hope your child gets out of this group?

7. ➜

How would you describe your child’s current level of comfort and engagement with the natural world?

8. ➜

What are your child’s strengths? Or...how do they surprise and delight you?

9. ➜

On a scale of 1-10 (1 low, 10 high), how interested is your child in attending this group? (Feel free to ask them and know we don’t expect 10s! A certain level of trepidation/uncertainty is perfectly normal. We just want to make sure they aren’t so low in interest that the group may be a waste of time and money for them and you.)

10. ➜

Are you and your child able to commit to attending at least 4 of the 5 sessions, barring illness/last minute life events? (The connection between group members themselves is a huge part of why this type of experience is helpful--as much as possible, we’d like to have the same people there every week.)

11. ➜

If there are areas where your child is emotionally struggling right now? How would you describe those struggles?

12. ➜

Is your child receiving mental health support through any other providers at this time? Or are you looking for/wondering if your child could use some mental health support right now? If yes to either of these, would you be willing to speak with one of our group facilitators about why/how this is going? The intention is to help make sure this group will complement their other work and/or not be a replacement for work that may need to happen in a 1:1, more specialized setting. All mental health related information will be kept confidential.