B4Y: Bereavement for Youth Sign Up
Young adults and youth will be able to attend with their parent(s) and will have their own breakout discussion groups.
Date: October 2 - December 8,  @ 11:30AM -12:30PM
Age group:  Grades 4-12

As a part of Bethlehem’s Support Group Ministries, all participants are strongly encouraged to engage in one pastoral counseling session.
Sign in to Google to save your progress. Learn more
Classes Begin October 2 · 11:30AM · Virtual Meeting via Zoom
Who recommended this group? *
Parent's/Guardian's first and last names *
Parent's/Guardian's Email Address *
Parent's/Guardian's Phone Number
Address *
City *
State *
Zip Code *
Child's First Name *
Child's Last Name *
Age of Child *
Date of loss *
MM
/
DD
/
YYYY
List the relationship the child is grieving. Parent, grandparent, sibling, cousin, aunt, uncle, friend, teacher, neighbor, etc. *
Emergency Contact Full Name *
Emergency Contact Phone Number *
Does Bereavement 4 Youth (B4Y)have permission to take your videos/photos and/or videos/photos of your child(ren) of your grief journey for promotional purposes as a testimony for others? *
Bethlehem Assembly of God is attempting to track better those who participate in our programs, such as Bereavement 4 Youth (B4Y). By agreeing below, you grant permission for us to enter the pertinent information on your and/or your child(ren) into our database. This information will not be released or sold to anyone. It is being requested simply for tracking of participants in our programs. *
I understand that Bethlehem Assembly of God Bereavement4 Youth(B4Y) is not a clinical, therapeutic, or mental health program but a Biblical-based Christ-Centered Program to help deal with loss in a group setting. *
Required
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms