GriefShare Sign Up
There is a $15 fee for materials.

Young adults and youth will be able to attend with their parent(s) and will have their own breakout discussion groups.
Classes Begin January 16 · 10AM · Virtual Meeting via Zoom
First Name *
Last Name *
Address *
City *
State *
Zip Code *
Preferred Phone Number
Email Address *
Number of People Attending *
Your loss - who was it? (husband, wife, son, daughter, mother, father, etc.) *
Date of loss *
MM
/
DD
/
YYYY
Does Bethlehem Assembly of God - GriefShare Support Group have permission to take your picture or use recorded video of your grief journey for promotional purposes as a testimony for others? *
Bethlehem Assembly of God is attempting to do a better job at tracking those who participate in our programs such as GriefShare. By agreeing below, you grant permission for us to enter the pertinent information on your and/or your child(ren) into our database. This information will not be released or sold to anyone. It is being requested simply for tracking of participants in our programs *
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy