REGISTRATION - A Day Of Understanding
WHAT: Children's Grief Retreat (K-12)
Sponsored by HUGs from Cara
WHERE: 108 South St (PERC/Case Mansion
Auburn NY 13021
WHEN: Saturday March 30, 2019
TIME: 10:00-2:00 - Lunch included
FREE EVENT
DEADLINE FOR REGISTRATION: March 22, 2019

Email address *
Child's Name *
Your answer
Child's Age *
Your answer
Parent's Name *
Your answer
Phone Number *
Your answer
Would you like to be added to our mailing list? *
What was the relationship your child had with the person who died? *
Date of loved ones death *
MM
/
DD
/
YYYY
Has the child had any formal counseling ?
Is the child having any specific issues related to grief? (ex: drug use, thoughts of suicide, depression, anxiety, acting out, grades dropping, etc.) Please explain.....
Your answer
Agreement/disclaimer *
By entering your name below you agree to allow HUGs from Cara to use photographs, images and/or videos taken of myself or my child/children for use in materials that include, but may not be limited to, printed materials such as Brochures, Newsletters, Videos and digital images used on HUGs from Cara's Website and Social Media Pages, such as Facebook and Instagram and for our Fundraising Events to help raise awareness for grieving children.
Required
Please enter your full name to give HUGs From Cara permission for the use of photos.
Your answer
How many people (including children) will be attending the pizza luncheon/info session at 12:30? Parents, caregivers and family members are all invited. *
Your answer
Does the child have any medical issues we should be aware of? Please explain... *
Your answer
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