Green Country Psychology
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D&D Group Signup
Please complete this form so that Dr. Tim Doty and Green Country Psychology can contact your family for a brief follow-up phone screen to assess group appropriateness.
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Name of Caregiver/Parent/Guardian
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Last
Student/Adventurer Name
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First
Last
Email
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Parent/Caregiver contact info
Phone Number
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Adventurer's Age
*
10
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17
Challenge you would like your student to improve upon:
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Please briefly describe a challenge your student faces that you hope can be improved upon during their participation in a D&D Social Skills Building Group
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