Nani Clem
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Nani Clem
Registration for Safe & Free Expression
Name
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First Name
Last Name
Email
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Phone
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I am a:
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Check all that apply
Parent
Caregiver
Teacher
Other
Which technologies do you have access to?
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Check all that apply
Smart Phone
Computer
Internet
Zoom
Headphones
How did you hear about Safe & Free?
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In what ways do you experienced a lack of self expression and/or trust?
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In what ways are you anticipating Safe & Free will support you?
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As you learn how to hold space for full spectrum emotion, who in your life would be most affected by this work?
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Which day would work best for your 1:1 session
Please select your top three options.
Monday Before Noon
Tuesday Before Noon
Tuesday After 5pm
Thursday Before Noon
Scholarships are available for BIPOC, AAPI, persons with a disability, and those in need of financial assistance. Would you like more information?
Yes
No
Thank you for registering for Safe & Free. You will receive a respond within 24-48 hours.