What We Do

School Group Registration

School-Based Grief Support Group

To register your child(ren) for a school-based grief support group, please complete the School Group Registration Form below. Once submitted, a Mourning Hope staff person will contact you directly for additional details and information about our groups and events.

If you prefer, you may download a School Group Registration Form.

School Group Registration Form

First Name
Last Name
Relationship to Child:
Country
Address Line 1
Address Line 2
City
State
Postal Code
Cell Phone Number:
First Name
Last Name
Child's Age:
Child's Grade in School:
Are there any language, disability, and/or religious needs we should be aware of?
If "Yes", please explain:
Are there any other special needs, family customs, or cultural considerations we should be aware of?
If "Yes", please explain:
Name of the person who died:
If "Other" please detail here:
Date of death (month/day/year):
Age at time of death:
Circumstances of the death (illness, overdose, stroke, heart attack, suicide, homicide, etc.)
Please indicate if either of these statements are true:
Please explain:
Is your child able to speak openly about the person who died?
Is your child able to speak openly about the person who died?
Please explain:
Have there been other deaths your child has experienced? (Include relationship, cause of death, and date)
Has your child received any support from the school staff?
Please explain:
How has your child changed since the death?
Reaction to the loss:
Please check any behaviors your child has exhibited since experiencing the death:
Other life stressors:
Please check any situations that apply to your child:
Please provide a brief explanation for each stressor:

The Mourning Hope Grief Center is a nonprofit organization that relies on grants and donations to provide services to the community. The information below is required as part of the grant process, but will not be shared publicly.

 

Household Income:
Does your child receive Free/Reduced Lunch at school?
Child's Racial/Ethnic Origin:
By typing my name in the signature box, I am giving consent for my child to attend Mourning Hope's school-based grief support program. I understand that Mourning Hope will provide peer grief support group services facilitated by a trained Mourning Hope staff member and the school counselor/social worker or trained school personnel and is NOT a professional counseling service. I understand that Mourning Hope's staff and volunteers will respect student/family confidentiality except in the cases of suspected child abuse/neglect or expressed suicidal/homicidal intent.
Today's Date (month/day/year)