SJD Healing Hub

Name *

First Name

Last Name

Phone

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###

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Interest

Please select one or more options below:

I am interested in contributing financially to someone else's counseling session.

I am interested in volunteering my time or skills to support this initiative.

I would like to receive updates about the Counseling Initiative.

Are you licensed or certified in any of the following areas?

Counseling or Therapy (e.g., Licensed Professional Counselor, Marriage and Family Therapist)

Physical Fitness (e.g., Certified Personal Trainer, Group Fitness Instructor)

Nutrition (e.g., Registered Dietitian, Certified Nutritionist)

Other Relevant Certification (please specify below)

I understand that my information will be kept confidential and will only be used for the purposes of this initiative.

Yes, I accept