Interest Form

Thank you for your interest in Safe Harbor. This brief form helps ensure the group is a good fit for you and that expectations are clear.

1. Name (First name is sufficient) *
2. Email Address *
3. What drew you to Safe Harbor? (Share as much or as little as you’d like) *
4. What are you hoping to get out of this space? (There is no right answer) *
5. Safe Harbor is a facilitated peer-support and emotional processing group, not group therapy. Please check the boxes to confirm you understand: *	I understand this is not therapy I understand the facilitator is not acting as a therapist I understand this group does not replace individual therapy or crisis services
6. Which statement best describes you right now? *
7. Is there anything you want the facilitator to know to help support safety or inclusion in the group? (Optional)
8. Group Logistics Each closed group of 10 runs for a 4-week cycle. Please confirm: *	I can commit to attending the 4-week cycle or will inform facilitator so someone else can be moved from the waitlist. I understand the group is limited to 10 participants per session I understand group agreements will be reviewed at each session
9. Do you currently have support outside of this group? (This could be friends, family, therapy, community, or other supports) *
	10. Crisis Resources Acknowledgment — I acknowledge that if I need immediate crisis support, I can call or text 988 (Suicide & Crisis Lifeline) *

Your privacy matters. Details you share here are confidential. We’ll reply with next steps and scheduling options.

ASK@SAFEHARBORFM.ORG

2026