Intake Form to Request Services.

Whether you're a First Responder, Veteran, family member in need of assistance, or an amazing donor/volunteer that needs services, please fill out this survey so we can assist you.

We are serious about our mission, and we look forward to serving you.

Welcome to our anonymous chaplaincy & peer support form. All information collected is necessary to provide services for you, but kept completely confidential. No personally identifying information or uploads are required. We look forward to the opportunity to serve you, and help you find comfort where you are.

Should you feel you are a threat to yourself or others, or if you need medical attention, stop filling out this form and call 911 or visit the closest emergency room.

Full Name (Optional)

Phone *

Email

Occupation *

More Details

I Consent to Receive SMS Notifications, Email Alerts & Occasional Marketing Communication from Guardian Grounds Ranch & Camp Comrade. Message frequency varies. Message & data rates may apply. Text HELP to +1 866-720-2024 for assistance. You can reply STOP via SMS, or click "unsubscribe" in the email to unsubscribe at any time.

All Information is Kept Secure & Confidential

Privacy Policy | Terms of Service

What type of service(s) can we provide you with? *

Peer Support Specialists

Chaplaincy Support

Other (Describe Below)

Date Request Submitted *

What other services may we assist you with?

Have you ever used our services before? *

All Information is Kept Secure & Confidential

This information is obtained only to improve your experience with Guardian Grounds Ranch & Camp Comrade. All answers are kept confidential and only utilized to provide services needed, or suggest opportunities to you.

1. Have you served in the military or as a first responder? *

2. Have you received any previous mental health or peer support services? *

3. Are you comfortable discussing any traumatic experiences you may have had during your service? *

4. Have you ever worked with a chaplain before? *

5. Are you currently connected with any peer support groups/organizations for veterans or first responders? *

6. Are there any specific triggers or concerns we should be aware of when providing you with services or accommodations? *

7. How can we best support and assist you while receiving services for mental wellness, chaplaincy, or peer support? *

8. Please tell us anything about you that we may have missed above! *

9. What activities/hobbies do you enjoy? *

10. Please list any current exercise and stress reduction activities. *

Thank you for taking the time to provide us this information. We absolutely value your privacy and make every attempt to keep your information completely anonymous, private and secure. The information collected on this form is necessary to provide you with services. We will be in touch as soon as possible to assist you.

If you feel you are a danger to yourself or others, or in need of medical attention, please call 911 or visit the nearest emergency room.

FAQS

How can I donate?

We have a convenient donation form here. If you're interested in an event for your donation, or making a large donation, please email
[email protected] to get more information.

Where does my money go?

Our board members are volunteers and 100% of your funds go toward creating the ability to provide services directly to Veterans and First Responders through our 501c3 campgrounds. We are committed to transparency and finances matter. We vow to spend all money judiciously, and only to further the mission of helping our brothers and sisters in need.

How do I get help?

If you're a Veteran or First Responder and are having suicidal thoughts, or need immediate assistance, please call 911. If you need help with your fight, we are your battle buddy. Fill out a Contact Us form now and someone will be in contact with you shortly.