FOCUS Clubhouse Membership

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Because everyone wants to belong somewhere!

Membership is FREE!

PRELIMINARY membership application

Please note: Safety is paramount in any environment, not only for the staff but for our members. Membership is free of charge and while we welcome everyone, we do wish to stress bullying, violence, sexual harassment, unbecoming conduct, etc. is NOT TOLERATED. Please read the rules and regulations and abide by them to promote a harmonious clubhouse for everyone.

* Indicates required field

Name *

First

Last

Gender *

Male Female Prefer not to say

Age *

Phone Number *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Email *

Are you diagnosed with a mental illness? *

Yes No Inquiring for friend or loved one diagnosed with mental illness.

Do you *

drive yourself take the bus ride with friends

Are you employed? *

No Full Time Part Time Self-employed

Have you ever been convicted of a violent or a sexual crime? *

Yes No

If so, please explain. *

Are you on probation or parole? *

No Probation Parole Work release

Are you in substance abuse counseling or a program for substance abuse? *

No Yes

Why are you interested in FOCUS Clubhouse? *

Additional Comment *

Submit

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HOME
ABOUT US
Daily Working Units
EVENTS
MEDIA
GALLERY
ONE MAN'S VISION
Referral Form (for Clinicians)
MEMBERSHIP
Board Blogs and News
BUY A BRICK DONATION
RESOURCES
DONATE
FAQ
Stats on Mental Illness
SENIOR COVID-19 CARE
CLUBHOUSE INTERNATIONAL STANDARDS
Find a Clubhouse
SOLA Giving Day
CONTACT
Unmasking Mental Health