Services

Mourning in Motion Registration

Mourning in Motion Registration

To register for Mourning in Motion on Saturday, July 20, please complete the Registration Form below.

  • Open to children ages 6 to 11
  • 9:30 a.m. to 11:30 a.m
  • Caregivers are to drop off and pick up youth at the appropriate times

Please Note: Mourning in Motion has a 15-participant maximum. Upon receiving your registration, a Mourning Hope staff member will contact you and confirm space availability; your child(ren) is/are not officially registered until that contact has been made.

Registration Form

First Name
Last Name
Country
Address Line 1
Address Line 2
City
State
Postal Code
Cell Phone:
Name of the person who died:
Date of death (month/day/year):
Decedent's relationship to you:
If "Other", please detail here:
Has/have your child(ren) attended other Mourning Hope groups/events?
(i.e. Family Grief Support Group, Bits of Hope, Holiday Hope, Art From Our Heart, Spirit of Giving, etc.)
First Youth Attending
Age
Youth's School
Registering for:
Second Youth Attending
Age
Youth's School
Registering for:
Third Youth Attending
Age
Youth's School
Registering for:
Decedent's relationship to child(ren):
If "Other", please detail here:
Is English the primary language spoken in the home?
Mourning in Motion includes refreshments; please list any food allergies for participants:
Please list any mental or physical disabilities and accessibility needs for participants:

Funding agencies often require nonprofit organizations to maintain client information related to gender, race, age, and income level. The requested information is strictly for the purpose of Mourning Hope's compliance with these record-keeping requirements. Responses will remain anonymous, and are greatly appreciated.

My child receives free/reduced lunch at school:
How many people live in your household?
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.