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For Salesforce
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These fields must be hidden, participants will not see this section.
Use the Default Value field under "Options" to enter the value for all participants

Program or Project (enter the program or project the form is associated with)

Program Cohort (enter exact cohort name from Salesforce)

Owner (Enter the name of the staff member responsible for the form)

Form Name (enter the exact form name in Form Assembly)

GCAPP's FREE (Virtual) Mental Health Support Group Sessions

For Teens Ages 14-17: Thursday, July 16^th from 5pm-6pm

For Young Adults Ages 18-24: Thursday, July 16^th from 6pm-7pm

For Your Parents/Trusted Adults: Thursday, July 30^th from 6pm-7pm

Thank you for your interest in attending a FREE (Virtual) Mental Health Support Group Session this Summer! This Support Group will be facilitated by a Mental Health Professional, alongside the help of GCAPP staff and Youth Advisory Council Members. Please complete this Registration Form so we know how many people to expect at these sessions.

Your responses are confidential and will be kept private to the fullest extent allowed by law. Any personal information you provide, including your name and email address, will be securely stored and used only by GCAPP for purposes related to this survey and follow-up communication. Individual responses will not be shared publicly.

By providing your contact information, you consent to GCAPP contacting you with information about programs, resources, events, and awareness initiatives related to our mission. Your information, including your email address, may also be used to support outreach and engagement efforts, such as connecting with you on social media. You may opt out of these communications at any time.

Participant Information

First Name

Last Name

Email

Phone

Please select the attributes that describe you

Youth (14-17)

Young Adult (18-24)

Parent/Caregiver

County of Residence

Zip/Postal Code

Year

Which Support Group Session will you be attending?

Teen Session (ages 14-17): Thursday, July 16th from 5pm-5:45pm Young Adults Session (ages 18-24): Thursday, July 16th from 6pm-6:45pm Parents/Caregiver Session: Thursday, July 30th from 6pm-6:45pm

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Demographics

Race / Ethnicity

Gender

Personal Pronoun

Sexual Orientation

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Connect with us on Social Media

If you would like to share, please provide your social media handle(s). This information is optional and will only be used to connect with you about relevant content, programs, or community engagement opportunities.

Facebook	Instagram
TikTok

Follow GCAPP on Social Media

We invite you to follow or like GCAPP on social media to stay connected and receive updates, resources, and upcoming opportunities.

Every follow, like, or share helps extend our reach and strengthens our efforts to support and promote health for young people in Georgia.
GCAPP on TikTok

Click the links below to follow us.

GCAPP on Facebook
GCAPP on Instagram
GCAPP on TikTok