Children’s Grief Support Group Sign Up Form

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We’re so excited to roll out our new Support Group for children that endure the death of their parent or sibling.

Parent or Guardian- you will be leaving your child/ren in the care of two grief professionals. You can have an hour to yourself at the local coffeeshop or whatever you’d like to do.

The children will sometimes have “homework” which is encouraged to be done with their guardian or parent. It’s easy homework and is meant to bring families together through the grieving process.

If you have any questions at all, feel free to ask!
Please fill out this form each time your children have an interest in coming to the group and plan on attending so we can get an accurate amount of supplies for the workshops.

1. Child’s First and Last Name *

1a. Date of Possible Attendance: *

YYYY

2. Child’s Age

3. Other Child/ren Attendants- Names and Ages: (if none then put N/A)

4. Health history & Any Concerns worth noting for children:

5. Child/ren’s Allergies:

6. Name of person deceased

7. Relationship to child/ren attendants *

Emergency Contact: *

Name of drop off person *

Contact number while child/ren are in group? *

Any other needed information: (if none, put n/a)

Any type of behavioral issues or concerns? If so, please describe.

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