Join the healing revolution

Fight Club is a holistic 14-week program for women who are survivors of trauma* to begin a journey of healing through boxing, yoga, group talk therapy and individual counseling. Due to COVID-19, Fight Club will only be provided in virtual format for the fall 2020 cohort with the opportunity to connect with fellow classmates through social distanced opportunities.
*Trauma related to human rights includes but is not limited to: War, persecution of religion, sexual orientation and freedom of speech, violence, domestic violence, human trafficking, sexual abuse, sexual assault, rape, poverty, incarceration, racism

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* 1. Contact Information

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* 2. Date of birth

Date

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* 3. Which of these best describes your current gender identity? (cisgender refers to identity and gender that corresponds with your birth sex)

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* 4. Please describe your race/ethnicity.

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* 5. Which of these best describes your sexual orientation?

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* 6. Income range

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* 7. What is the highest level of education you have completed?

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* 8. English reading/writing proficiency

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* 9. Languages spoken

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* 10. What is your experience with yoga?

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* 11. What is your experience with boxing?

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* 12. What is your experience with counseling?

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* 13. Have you ever had the following issues while seeking mental health care? Please check all that apply.

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* 14. Do you have a preference on the gender of your therapist?

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* 15. Do you have a preference on the ethnicity of your therapist?

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* 16. Will your schedule allow you to commit to Fight Club for an hour and a half twice a week?

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* 17. Will you commit to seeing a counselor for the 14 weeks of the program?

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* 18. Do you prefer morning, afternoon or evening classes? Check all that apply.

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* 19. Have you ever received a mental health diagnosis other than depression, anxiety or PTSD?

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* 20. Do you struggle with any of the following? Check all that apply.

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* 21. Do you have a history of suicide attempts and/or suicidal thoughts? Check all that apply.

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* 22. Are you currently in a physically or verbally abusive relationship?

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* 23. Do you feel safe (free of being harmed or abused) at home and at work? Check all that apply.

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* 24. Do you have any underlying health conditions?

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* 25. Are you a veteran or first responder?

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