Taking Action Registration Form
We invite all young people between the ages of 16-24 to join Taking Action for Whole Health and Wellbeing in-person sessions at Youth Uprising, 8711 Macarthur Blvd., Oakland, CA 94621
 
Tuesdays 3:30-5 pm, February 24 - March 31, 2026 (six weeks)

Taking Action is a structured system used to self-manage mental health.  It is an empowering process involving mutual sharing of stories, ideas and insights. As a result, you decide what is best for you.

Any questions?  Contact vsaka@peersnet.org or (510) 567-7617.
Sign in to Google to save your progress. Learn more
First Name: *
Last Name: *
Best Form of Contact: *
Cell Phone Number: *
Date of Birth: *
Date
Email Address: *
Do you have any dietary restrictions /food preferences?
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of PEERS.

Does this form look suspicious? Report