Siksika Mental Health Group Registration Form

Siksika Mental Health Group Registration Form

Thank you for your interest in participating in this group. This is a closed, community-based group designed to provide participants with a safe, respectful, and confidential environment where they can connect, share experiences, and support one another.

Name
Preferred Method of Contact

Emergency Contact Information

Emergency Contact

Group Readiness & Safety (Community Setting)

Are you currently experiencing a level of distress that feels overwhelming or unsafe?
Are you connected to any other supports (Elder, therapist, community worker, support group)?
Do you feel able to participate in a group setting where others may share personal experiences?
Confidentiality & Participation: This group is supportive and wellness-focused and does not replace counselling, medical care, or crisis services. Participants are expected to respect others and maintain confidentiality.
Registration & Acceptance: Submitting this form does not guarantee acceptance into the group. Participants who are accepted will be contacted.
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