Preview mode
Published
Copy responder link
Virtual Grief Group Registration
Greetings,

ARROW Project is a grass-roots, mental-health focused non-profit serving the Shenandoah Valley Predominantly. ARROW Project is working with community partners to increase access to mental health services both to individuals historically underserved due to access and affordability as well as provide unique opportunities for community members to engage in mental health curriculum. We hope this will reduce the harmful effects of stigma and provide an environment where individuals can speak out about mental health challenges they may be experiencing. 

By submitting your contact information and signing the informed consent below, you are enrolling in ARROW Project's Virtual Grief Group.  This support group is for adults (18+) looking to understand grief and loss and to develop skills to manage grief in one's personal life.  We will offer a warm and supportive environment for all to explore their relationship with grief. We will utilize expressive arts, psychoeducation, and conversation as we journey together through the landscape of loss. This is an open group, meaning it is an ongoing, continuous therapy group that allows new members to join at any time and to come, go, and participate as needed.

Time: Weekly on Wednesdays, 7:00-8:00 pm (with occasional breaks)
Location: Virtual - Link to join will be emailed 

If you would like to participate, we ask that you review and sign the informed consent form below.

If you have questions, please feel free to contact us directly at the contact information listed below.

Warm regards,

Julien Ocansey
Student Clinician, MA in Clinical Psychology Program
julieno@arrow-project.org

Aspen Eichelberger
Undergraduate Volunteer, Old Dominion University Psychology Program

Rebecca Jett
Undergraduate Intern, Bridgewater College Psychology Program
bjett@eagles.bridgewater.edu

Jules Lombardi
Undergraduate volunteer, Bridgewater College Psychology Program   


Referred by (if applicable)
Are you 18 or older? *
Your Full Name *
Your Phone Number *
Your Email Address: *
Emergency Contact (or Guardian, if applicable)
 *
Emergency Contact (or Guardian) Phone Number *
Please read carefully before signing below.

This outlines the details of the Virtual Grief Group Therapy Program that you are registering to join at ARROW Project. We encourage you to discuss any questions you may have with the group leaders before signing this consent form. Group therapy provides a supportive environment where you can discuss with other people facing similar experiences in a safe space. This weekly group is open to adults (18+) and focuses on exploring, understanding, and managing grief and loss through expressive arts, psychoeducation, and conversation.

What to Expect in Group Therapy:

Confidentiality:
All information shared within the group with ARROW staff will be kept confidential, with the exception of situations where there is a risk of harm to self or others and as required by law.

Group norms:
Ground rules will be established to ensure respectful interactions within the group.

Session structure:
Sessions may focus on specific topics, including discussions, activities, and sharing experiences.

Potential Benefits:
Improved coping skills, Increased self-awareness, Reduced anxiety and stress, and Positive peer support.

Potential Risks and Discomforts:
Sharing personal experiences may feel uncomfortable at times. Group dynamics can be challenging, including potential conflict with other group members. Discussing sensitive topics could lead to discomfort and feelings of distress.

Your Right to Withdraw:
You can withdraw from group therapy at any time by notifying group leaders.

Group Member Responsibilities:
Participate in group sessions. Communicate any concerns you may have about the group therapy process. 

By signing below, you acknowledge that you have read and understood this informed consent document and agree to your participation in the Virtual Grief Group Therapy Program at ARROW Project. 
 *
Your Electronic Signature *
Guardian's Electronic Signature (if applicable)
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Google Forms