GriefShare Registration Form

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This form is to be completed and submitted by those individuals wishing to register for the 2024 session. Two sessions will be offered: Wednesday evenings 7:00 p.m. - 9:00 p.m., and Thursday mornings 10:00 a.m. - 12:00 p.m. There will be 13 weeks in each session beginning Wednesday, September 11th and Thursday, September 12th. Registration fees cover the cost of resource material used during the course.

Email *

Name: *

Address: *

Phone Number: *

Emergency Contact
Name and Phone number *

How did you hear about GriefShare? *

Whom have you lost in death? *

Date of loved one's death: *

YYYY

Is there anything about your situation that you would like to share?

Please check off which session you are registering for:
*

Wednesday evenings starting September 11 from 7:00 p.m. to 9:00 p.m.

Thursday mornings starting September 12 from 10:00 a.m. to 12:00 p.m.

Registration fee of $25 for the workbook. Please check one of the following methods of payment:
*

Cash (Please indicate that cash is for GriefShare workbook)

Cheque (Please indicate that cheque is for GriefShare workbook)

E-transfer to donate@bendale.com. (Please indicate that e-transfer is for GriefShare workbook)

Please cover my fee from the scholarship fund

I understand confidentiality is mandatory in the group and that anything said in the group is to stay in the group. I understand that GriefShare is not counseling but a group led by volunteers. Childcare is not provided. *

Yes

A copy of your responses will be emailed to the address you provided.

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