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.
* Required
Classes Begin January 16 · 10AM · Virtual Meeting via Zoom
First Name
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Your answer
Last Name
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Your answer
Address
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Your answer
City
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Your answer
State
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Your answer
Zip Code
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Your answer
Preferred Phone Number
Your answer
Email Address
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Your answer
Number of People Attending
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Your answer
Your loss - who was it? (husband, wife, son, daughter, mother, father, etc.)
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Your answer
Date of loss
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MM
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DD
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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?
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Yes
No
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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
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