Registration – K/TG2

Kids & Teens Grieve Too

Dates:
Orientation	Tuesday – Oct. 19
Kids/Teens	Tuesdays – Oct. 26, Nov. 2, 9, 16, 23 & 30
Parents/Guardians	Thursdays – Oct. 28, Nov. 4, 11, 18, 25 & Dec. 2
Time:	6:30 – 8:00pm
Platform:	Zoom

 

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Registration

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Child's Name *

Date of Birth *

Home Address *

City *

Province *

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Postal Code *

Home Phone *

Parent/Guardian Work Phone

Email *

Parent/Guardian Name(s) *

Emergency Phone *

Allergies?

Name of Deceased

Relationship to Child

Date of Death

Does the child know the exact cause of death?

Yes

No

How did the child learn about the death and who told them?

Has the child received any professional support to help deal with their grief? If yes, please outline:

Have there been other losses? (Pets, divorce, moves, etc.)

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