Mending Hearts Sharing Time Network Application

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Thank you for you interest in being a part of the Mending Hearts Sharing Time Network!

This application is for Memphis area adults over the age of 18 that lost one or both of their parents during their childhood (age 18 and under) that would be willing to volunteer their time to speak to Mending Hearts Campers about their experience growing up with their loss and the challenges and successes that come along with it.

Mending Hearts has multiple sharing time opportunities each Summer, and is looking to broaden its list of adults to call upon for sharing time so that every camper can hear from a wide variety of perspectives throughout their years attending camp. While you may not be called upon to share in the upcoming camp season, the hope is to build a large network of adults that would be willing to share so that every year new faces can be introduced.

Please fill out the questions below and feel free to reach out to mendinghearts@orpheum-memphis.com with any additional questions!

Email *

First Name *

Last Name *

Preferred email *

Preferred Phone Number *

Current Age *

Birthdate *

YYYY

How do you self Identify? *

Check all that apply

Asian/Asian American

Black/African/African American

White/Caucasian

Hispanic/Latinx

Native American/First Nations

Native Hawaiian/Pacific Islander

Male

Female

Non-binary

Prefer not to answer

Prefer to write in answer (next question)

Please use this space if you prefer to write in self identifiers

Age(s) that you experienced the loss of your parent(s) *

Please briefly describe how your loss affected your childhood and how you have continued to keep hope and celebrate the successes in your life despite losing your loved one at an early age.

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