What We Do

Family Registration

Family Registration

To register for the Family Grief Support Group please complete the Family Registration Form below. Once submitted, a Mourning Hope staff person will contact you directly with additional details and information about our groups.

Please contact Alyssa Christensen, Grief Support Director, at achristensen@mourninghope.org with questions.

Family Registration Form

First Youth Attending
Month
/
Day
/
Year
Youth's School
Youth's Grade
Youth's Age
Youth's Gender
Second Youth Attending
Month
/
Day
/
Year
Youth's School
Youth's Grade
Youth's Age
Youth's Gender
Third Youth Attending
Month
/
Day
/
Year
Youth's School
Youth's Grade
Youth's Age
Youth's Gender
Fourth Youth Attending
Month
/
Day
/
Year
Youth's School
Youth's Grade
Youth's Age
Youth's Gender
Fifth Youth Attending
Month
/
Day
/
Year
Youth's School
Youth's Grade
Youth's Age
Youth's Gender
Sixth Youth Attending
Month
/
Day
/
Year
Youth's School
Youth's Grade
Youth's Age
Youth's Gender
Name(s) of Parent/Guardian/Caregiver(s) participating
Country
Address Line 1 *
Address Line 2
City *
State/Province *
Postal Code *
Cell Phone
Home Phone
Work Phone
Parent/Guardian/Caregiver(s) Employer(s)
Preferred method of contact:
Registering for:
Total Number of Youth (ages 6-9) Participating:
Total Number of Youth (ages 10-12) Participating:
Total Number of Youth (ages 13-18) Participating:
Total Number of Adults Participating:
*At least one caregiver must participate.
Is English the primary language spoken in the home?
Name of person who died
Circumstances of death
Have you attended the Family Grief Support Group before?
Other changes in your lives
Reason(s) family would like to participate in a support group
Reaction to the loss
Please check any behaviors your child(ren)/teen(s) has/have exhibited since experiencing the death:

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.

Age of Participant(s)
Please check all that apply:
Race of Participant(s)
Please check all that apply:

Age of Participating Caregiver(s)

Caregiver #1
Caregiver #2 (if applicable)
My Child Receives Free/Reduced Lunch at School
By typing your name in the signature box, you are giving consent to participate. You will receive a separate consent form to complete related to online support groups. 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.