Phone (402) 488-8989

What We Do

Mourning in Motion Registration

Mourning in Motion Registration Form

Children and teens who have experienced the death of someone significant need healthy, creative outlets to help them heal. Mourning in Motion is an opportunity for youth to come together with their peers to express their thoughts and emotions through movement.

First Name *
Last Name *
Country
Address Line 1 *
Address Line 2
City *
State/Province *
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:
How did you hear about this event?
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
Youth's Age
Youth's School
Student's Grade (in August 2023)
Second Youth Attending
Youth's Age
Youth's School
Student's Grade (in August 2023)
Third Youth Attending
Youth's Age
Youth's School
Student's Grade (in August 2023)
Fourth Youth Attending
Youth's Age
Youth's School
Student's Grade (in August 2023)
Decedent's relationship to child(ren):
Decedent's relationship to child(ren):
If "Other", please detail here:
Registering for:
Is English the primary language spoken in the home?
Do any of the youth participants have a fear of dogs?
There may be a therapy/comfort dog present.
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.

Race(s) of Participant(s)
Total Household Income
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.