Services

Family Registration

Family Registration

To register for the 10-Week Family Grief Support Group, Bits of Hope, Art From Our Heart and Holiday Hope, please complete the Family Registration Form below. Once submitted, a Mourning Hope staff person will contact you directly for additional details and information about our groups and events.

Please Note: While Mourning Hope attempts to accommodate all registrants for our grief support groups, programs do fill quickly and space is limited. Upon receiving your registration, a Mourning Hope staff member will contact you and confirm space availability; your family is not officially registered until that contact has been made.

If you prefer, you may download a Family Registration Form

Family Registration Form

First Youth Attending
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Youth's School
Second Youth Attending
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Youth's School
Third Youth Attending
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Youth's School
Fourth Youth Attending
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Youth's School
Fifth Youth Attending
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Youth's School
Sixth Youth Attending
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Youth's School
Name(s) of Parent/Guardian/Caregiver(s) attending
Country
Address Line 1
Address Line 2
City
State
Postal Code
Cell Phone
Home Phone
Work Phone
Parent/Guardian/Caregiver(s) Employer(s)
Preferred method of contact:
Registering for:
*Please note at least one caregiver must attend any multiple-week grief support group.
Is English the primary language spoken in the home?
Name of person who died
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Circumstances of death
Have you attended a 10-week session before?
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Other changes in your lives
Reason(s) participants would like to attend Mourning Hope
Please describe any problems the participants may be having (may include problems in school, at home, behavior changes, physical changes):
Mourning Hope sessions typically include refreshments; please list any food allergies:
Does your child have a dog allergy?
Does your child have a fear of dogs?
(A companion dog, similar to a therapy dog, may attend our 10-week and 4-week sessions.)
Please list any physical disabilities or accessibility needs for participants:
Questions or concerns?
By typing your name in the signature box, you are giving consent to participate and possibly be photographed for promotional purposes. The term "electronic signature" means a method of signing an electronic message that identifies and authenticates a particular person as the source of the electronic message; and indicates such person's approval of the information contained in the electronic message.