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KCGCF Group Intake Information
Thank you for reaching out to KCGCF, we are so glad you found us! Currently, we offer two options for regular grief support programming

Kin Club is for children aged 3-18 and their caregivers, it is held the 1st and 3rd Thursday of each month at Tates Creek Christian Church from 6:15pm to 7:30pm. 

Link is our 8-week online peer support program for teens aged 13-18. Groups are offered on a rotating basis. 

Please fill out this intake and we will connect with you via phone call to complete our intake process! 

**Please note, for both groups, we recommend waiting at least 3 months following the most recent loss to participate.
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Which program would you like to enroll?  *
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Name 
Number of Children/Teen(s) Registering
Phone number
Email
Best time of day to contact: 
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Who died, and how are you related to or connected to them?
How did they die/what was the cause of death for each person?
Have you experienced multiple losses?
How long has it been since the most recent loss?
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