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Enroll in Youth Peer Group

This form is intended for those who wish to enroll in, or receive more information about, our youth APG program. This program is for individuals ages 12-17 and ages 18-25 experiencing problematic substance use and/or mental health symptoms. Please provide us with your information so that our program manager can reach out to you within 48 business hours. We are currently enrolling youth in our groups that meet on Wednesdays, 4:30-5:30pm for ages 12-17 and 6:30-7:30 for ages 18-25. We have a waitlist available for individuals interested in a different day/time.

Who is filling out this form?*
- Youth seeking services
- Adult seeking services for a youth
Youth First Name*
First
Adult First Name*
Last
Youth Age Group*
- Ages 12-17
- Ages 18-25
Best Phone Number To Reach You*
Okay to leave voicemail?*
- Yes, you can leave a voicemail
- No, don't leave a voicemail
If you select "No" we will try to reach you a total of three times without leaving any voicemails.
Add a Message
ARCNH Updates
- I'd like to receive email updates about ARCNH events and programs.
Email*

Connect with ARCNH

Name*
First Last
Email*
Phone
What can we help you with?*
Please select the option that matches most closely to why you are contacting us today.
- Sign up for email donation receipts
- Sign up for fundraising updates
- Sign up for our newsletter
- Other comments/questions
Your Message
Opt-in*
- I understand that ARCNH may occasionally contact me with updates on programs and events and I may unsubscribe at any time.

Contributor Contact

Name*
First Last
Organization Name*
Email*
Phone
What can we help you with?*
Please select the option that matches most closely to why you are contacting us today.
- Sign up for email donation receipts
- Sign up for fundraising updates
- Sign up for our newsletter
- Other comments/questions
Your Message
Opt-in*
- I understand that ARCNH may occasionally contact me with updates on programs and events and I may unsubscribe at any time.

CONTACT US

603.554.8142

recover@arcnh.org

180 Elm St, Suite E
Milford, NH 03055

603.554.8142

recover@arcnh.org

180 Elm St, Unit 5
Milford, NH 03055

THANK YOU TO OUR CONTRIBUTORS!

Contact Us

THE CENTER

OTHER RESOURCES

GET ARCNH UPDATES

CONTACT US

603.554.8142

recover@arcnh.org

180 Elm St, Suite E Milford, NH 03055

603.554.8142

recover@arcnh.org

180 Elm St, Unit 5 Milford, NH 03055

THANK YOU TO OUR CONTRIBUTORS!

Contact Us

THE CENTER

OTHER RESOURCES

GET ARCNH UPDATES

180 Elm St, Suite E
Milford, NH 03055

180 Elm St, Unit 5
Milford, NH 03055