Winter 2025-2026 D&D Campaign Interest Form

D&D Social Group Interest Form

Hesed Counseling is excited to announce our intention to host a D&D Social Group this winter! This group will meet 1-2 times per month with the campaign being capped at a total of 6 sessions. The amount of times per month that the group will meet is dependent upon total interest. Age ranges for possible groups are 10-13 years old and 14-17 years old. If there is only enough interest for one group, then the singular group will meet twice per month, however, if there is enough interest to hold two separate groups, then each group will meet once per month for the duration of the campaign. A group will be capped at a total of 6 players. The interest form will remain open for each age range until filled.

Group will meet on specified Fridays from approximately 7-9pm at our Wilmington location of Randall Parkway. Sessions will be DM’d by Kayla Moreno Vega, MSW, LCSW and assisted by Miranda Spencer, graduate student intern.

Participation in the group will be self-pay only (HSA/FSA accepted!). Insurance will not be accepted as this is a social group, not a therapeutic group. The total introductory cost is $180/participant. $180/6 = $30/session or $15/hour.

In order to help us gauge interest and plan for this group, please complete the following questions.

Current clients will be sent a separate interest form. If you are a current client at Hesed Counseling, please do NOT complete this form.

Parent/Guardian Name

First Name

Last Name

Parent/Guardian Phone

(###)

###

####

Parent/Guardian Email

Participating Child's Name

First Name

Last Name

Child's Age Range

10-13yo

14-17yo

Please use the box below to type any questions/concerns you have regarding which age range group your child would thrive in the most.

(Please leave blank if you do not have any concerns)

Gender of child participating in group

Finances

I am able to pay in full prior to the start of the campaign

My child is interested, however, we need to discuss a payment plan before we can officially commit.

Please type your name acknowledging your understanding that completing and submitting this form does not guarantee your child's spot in the D&D campaign, but is simply expressing interest. You are NOT locked in and can back out at any time before payment is collected.