Village Alumni Group Registration Form

Where we grow & thrive together. Recovery isn't just about the individual — it's about strengthening the entire village around them.

Contact Information

Name
Preferred Method of Communication:

Referral Information

Did you complete the 5-week Village Education Series?
How did you hear about the BriteLife Village?

Relationship Information

What is your relationship with the patient/your loved one in treatment?

Loved One’s Current Status

What BriteLife Facility have you been connected with:(Required)

Duration of Experience

How long have you been navigating this situation?

Which topics are most relevant to you right now?

Which topics are most relevant to you right now?

Previous Support Experience

Have you previously participated in a family support group?

Goals for Participation

Are you interested in participating in The Village Alumni virtual support groups?(Required)
Are you interested in participating in Alumni events at BriteLife locations?

Group Agreements & Consent