GRIEFSHARE REGISTRATION
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Please complete this form to assist us in preparing for you.
Name
*
Age
*
Please select one option.
20 and younger
21 to 30
31 to 40
41 to 50
51 to 60
61 to 70
70 +
Email
*
This address will receive a confirmation email
Phone
*
I will need to use the childcare offered
*
Please select one option.
Yes
No
Undertaking: I understand confidentiality is mandatory in my group and that anything said in the group is to stay in the group. I understand GRIEFSHARE is not counseling, but a group led by volunteers. I also understand the volunteers and/or leaders of this program have an obligation to report any disclosure of intent to harm oneself or others to the pastors at Emmanuel Church, my church, or to any other appropriate agency.
*
Please select all that apply.
I accept
Please share a little about the nature of your loss
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Submit
Description
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