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
/
/
Youth's School
Second Youth Attending
/
/
Youth's School
Third Youth Attending
/
/
Youth's School
Fourth Youth Attending
/
/
Youth's School
Fifth Youth Attending
/
/
Youth's School
Sixth Youth Attending
/
/
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
Circumstances of death
Have you attended a 10-week session before?
Other changes in your lives
Reason(s) participants would like to attend Mourning Hope
Reaction to the loss
Please check any behaviors your child(ren)/teen(s) has/have exhibited since experiencing the death:
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 6-week sessions.)
Please list any mental or physical disabilities and 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.