Mental Wellness Request Form - H.U.M.A.N.I.T.Y 360, INC

Name *

First

Last

Best Contact Number *

Email *

Organization

Which Mental Wellness Program are you requesting? *

Adult Joy Workshop Ages 18+ (Individual)
Adult Joy Workshop Group
Young Leaders Mental Wellness Workshop Ages 10-18 (Individual)
Young Leaders Mental Wellness Workshop Ages 10-18 (Group)
Joy Program 1-on-1 School and Home Support (Ages 10 – 18)
The Joy Thinkers (Personal Support Program/Case Management Ages 18 – 60)
Family/Group Support and Gentle Parenting Help
Mental Wellness Development Training for Organizations

How would you like this service facilitated?

Virtual
In-Person

Please check all that you will provide. GROUP WORKSHOP ONLY

Meeting Space
Internet/Wi-fi
Projector
Printed Joy Workbook for each participant (Emailed Upon Completion)

Please select Internet/Wi-fi for virtual workshops.

How many participants do you anticipate? GROUP WORKSHOP ONLY

Min number of participants 5

Additional Questions/Comments *

Please include Date/Time of service requested, and preferred method (i.e. in-person, Zoom, Google Meets, etc.) Additional Rate Info: Joy Workshops-Session Rates vary per group size and equipment provided.