TTRPG Intake Form

1

Who is this group request for?* This field is required.You can request this appointment for yourself or on behalf of someone else. Please choose below.

Me

Someone Else

2

Your Name* This field is required.

First Name

Last Name

3

Your Email* This field is required.

example@example.com

4

Your Phone Number* This field is required.

Please enter a valid phone number.

5

Date of Birth* This field is required.

Date

6

Is the potential group member a minor?* This field is required.

Yes

No

7

Potential Group Member's Name* This field is required.

First Name

Last Name

8

Potential Group Member's Email

example@example.com

9

Potential Group Member's Phone Number

Please enter a valid phone number.

10

Potential Group Member's Date of Birth* This field is required.

Date

13

Have you ever had experience with table top games or Dungeons and Dragons before?

No Experience

Some Experience

Significant Experience

14

What are the goals/concerns to work on through this group?* This field is required.

15

How did you hear about us?