The Cole Project - Hope Program Registration Form
In what location are you interested in attending a group?
Salt Lake City
If under 18 name of parent or guardian
If under 18 parent or guardian phone number
Date of Birth
Are you a parent/guardian or a potential group member?
I identify my gender as...
Name & Age of Deceased
Relationship to Deceased
Cause of Death
Have you experienced any other losses in the last year?
Where did you hear about these groups?
I am interested in knowing more about or attending:
Peer support groups ages 13-15
Peer support groups ages 16-18
Peer support groups ages 19-23
Mobile support team (The Cole Project brings resources to your area)
Any other questions or comments?
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This form was created inside of The Cole Project.