Virtual Bereavement Support Group Form

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Our virtual sessions are facilitated by two bereavement volunteers via Zoom. PLEASE REMEMBER: The bereavement group is intended to provide peer-based support with facilitators’ guidance, rather than counselling. This group is for adults 18+ and is always free of charge.

First Name *

Last Name *

Full Address (in case of an emergency) *

Email *

Phone Number *

Emergency Contact Name *

Emergency Contact's Phone Number *

Please read and check all *

I recognize it is my responsibility to download Zoom prior to group and ensure I can access the meeting 10 minutes in advance of its start time.

I recognize it is my responsibility to troubleshoot any technical issues that may arise and ensure the appropriate updates have been installed.

I acknowledge that electronic communications are not secure and pose potential privacy risks.

I acknowledge this group is facilitated by volunteers.

I acknowledge my responsibility for my personal and mental health and will seek medical care or any other assistance which I may require.

I acknowledge that I have reviewed and agree to uphold the group guidelines, including confidentiality.

Required

Please confirm you are a human *

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