Registration for in-person and online Bereavement Support Groups - Journey Through LossJourney Through Loss

By clicking this Acknowledgement, you agree to adhere to the following guidelines to participate *

I Agree to the Following Guidelines

By participating in the Journey Through Loss Bereavement Support Group, you are agreeing that the confidentiality and privacy of all participants will be upheld. This is accomplished by ensuring the following:

• There is no one else present with you during the session who has not completed an intake process.
• You are in a private location.
• You are not taking screen shots or recording the session visually or audibly.
• You agree not to share the link to the Virtual Group with other members, friends, etc.
• You agree not to disclose any personal detail of any group member to anyone outside of the group itself.
• You agree that if you leave the session without notice, we may follow up with you by phone or email.

Fill in the information below and click submit. You will receive an email within 24 hours with details to join the group.

Name *

First

Last

Phone

Email *

Date / Time

Date

Time

If you have NOT previously had a live intake telephone interview with a JTL facilitator, you will be contacted directly to complete the intake interview prior to your first scheduled online or in-person meeting.

Intake Interview *

I HAVE previously had a live intake telephone interview with a JTL facilitator
I HAVE NOT previously had a live intake telephone interview with a JTL facilitator

As a registered member, you are able to attend either the online or in-person group. Please tell us how you would like to attend group initially.

Group Preference *

I would like to register for the in-person Bereavement Support Group
I would like to register for the online Virtual Bereavement Support Group

Please tell us how you heard about us (e.g., online, another member, funding partner, healthcare professional, etc) *

Online Group Please Note: While every attempt is made to assist individuals with registering to attend the online virtual bereavement group, it is expected that participants will be willing to download the necessary (free) software to their electronic device. This is a necessary requirement to gain accessibility to the online group.

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