In-Person Bereavement Support Group Registration

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Our in-person sessions will continue to be facilitated by two bereavement volunteers. PLEASE REMEMBER: The bereavement group is intended to provide peer-based support with facilitators’ guidance, rather than counselling. This group is for adults 18+ and is still free of charge. Attendees must wear a mask at this time.

Email *

First Name *

Last Name *

Address (in case of an emergency) *

Email *

Phone Number *

Emergency Contact Name *

Emergency Contact's Phone Number *

Please read and check all *

I understand it is my responsibility to self-monitor for COVID-19 symptoms and not attend group if I exhibit any

I acknowledge that electronic communications are not secure and pose potential privacy risks.

I acknowledge this group is facilitated by volunteers.

I acknowledge my responsibility for my personal and mental health and will seek medical care or any other assistance which I may require.

I acknowledge that I have reviewed and agree to uphold the group guidelines, including confidentiality

Required

Please confirm you are a human *

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

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