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The following is used for conversational purposes only and is optional.
First Name
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I am 13 years old or older *
While we are a confidential service, there are times we have to share information due to legal reasons such as danger to self/other or abuse/neglect. We are also required to report some information about our program to the State Department of Social Services. *

To enable Google Chat or SMS (text) communications please provide the following info:
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Verification: To complete the registration, solve the CAPTCHA and click "Start".
(this additional step helps prevent malicious and automated attempts to access the site)