Self-Serve Kiosk - Meeting and Activity Check-in
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What activity or meeting are you here for today?
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Recovery Meeting
Organization Meeting
Meet with Peer Specialist
Community Service Project
LRCC Event
Family Activity
Which recovery meeting are you here for?
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AA Meeting
NA Meeting
CAA Meeting
Living Free
Medication Assisted Recovery Anonymous
SMART Recovery
Refuge Recovery
All Recovery
Family Recovery
Harm Reduction Works (HRW)
Racist Anonymous (RA)
Sex and Love Addiction Anonymous (SLA)
Another Recovery Meeting Not Listed
Which recovery meeting are you here for?
Which organization meeting are you here for?
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Young People in Recovery
RCO Business Meeting
Harm Reduction Services Meeting
Oxford House (OH)
Change Today, Change Tomorrow (CTCT)
Diversity At The Table (DATT)
Are you a current member or volunteer?
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Yes
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Please enter your member or volunteer unique ID:
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First Name
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Last Name
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Email
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Confirm Email
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Are you interested in becoming a member?
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Address
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Address
Address
Address
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Date of Birth
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Gender Identity
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Gender Identity
Race/Ethnicity
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Alaskan Native
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Other Hispanic Ethnicity
Something else not listed
Race/Ethnicity
Please select all that apply.
Current Insurance Coverage:
No Coverage
Public Insurance (e.g., Medicaid/Medicare)
Private Insurance
Current employment:
Employed (Full Time)
Employed (Part Time)
Not Employed (including SSI/Disability/Retired)
Current Student (and not otherwise employed)
Current housing situation:
I live in my own apartment / home
I live with a friend or relative
I often have to sleep in a different place that is not my own
I am currently experiencing homelessness
Something else not listed
Current housing situation:
Current transportation status:
I have my own reliable transporation
I have easy access to public transporation
I have easy access to borrow a car regularly
I often struggle to find adequate transportation methods
How do you identify yourself?
As a person in recovery from a substance use disorder
As a person in recovery from a mental health disorder
As a person in recovery from a variety of things
As a family member or loved one of a person in recovery or struggling with substance use or mental health
I identify in a way not listed here
How do you identify yourself?
Are you interested in becoming a volunteer?
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Phone
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Days you are available to volunteer:
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Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
What are you most interesting in doing as a volunteer? What are your skills and interests?
Would you be willing to provide limited demographic information about yourself to help us improve our services?
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Yes
No
Gender Identity
Female
Male
Trans Female
Trans Male
Gender Fluid
Non-binary
Another identity not listed
Gender Identity
Race/Ethnicity
Alaskan Native
Asian
Native Hawaiian or Other Pacific Islander
American Indian
Black
White
Latino/Latina/Latinx
Other Hispanic Ethnicity
Something else not listed
Race/Ethnicity
Please select all that apply.
Current Insurance Coverage:
No Coverage
Public Insurance (e.g., Medicaid/Medicare)
Private Insurance
Current employment:
Employed (Full Time)
Employed (Part Time)
Not Employed (including SSI/Disability/Retired)
Current Student (and not otherwise employed)
Current housing situation:
I live in my own apartment / home
I live with a friend or relative
I often have to sleep in a different place that is not my own
I am currently experiencing homelessness
Something else not listed
Current housing situation:
Current transportation status:
I have my own reliable transporation
I have easy access to public transporation
I have easy access to borrow a car regularly
I often struggle to find adequate transportation methods
How do you identify yourself?
As a person in recovery from a substance use disorder
As a person in recovery from a mental health disorder
As a person in recovery from a variety of things
As a family member or loved one of a person in recovery or struggling with substance use or mental health
I identify in a way not listed here
How do you identify yourself?
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