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Bereavement Support Group (Virtual)

Wednesday, July 5, 2023
6:30 PM 7:30 PM

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All caregivers who have lost a child to their battle with cancer or another life-threatening illness are invited to join us for a Bereavement Support Group led by Melissa, our Comfort and Care Counselor and Program Coordinator

register

Caregiver's Name

First Name

Last Name

Caregiver's Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Caregiver's Email Address

Caregiver's Phone

(###)

###

####

Son/Daughter's Name

How did you hear about this event?

Additional Comments?

SMS and Email Opt-In

By checking the box, I give permission to be contacted about Amanda Hope Rainbow Angels by SMS text at my residential or cellular number or provided email address, dialed manually or by autodialer (consent to be contacted is not a condition to participate) and to be contacted via email. I consent to be contacted even if my phone number or email address appears on an Amanda Hope Rainbow Angels Do Not Call / Do Not Email List, a State or National Do Not Call Registry, or any other Do Not Contact List.

Attendance Policy

By checking this box, I agree to comply with the written policy below. By completing this form, I am registering for this Amanda Hope Rainbow Angels event. If at any point, I am no longer able to attend the event, I will immediately notify the Amanda Hope team via email (hello@amandahope.org) or phone (602-775-5090). If I do not notify the organization before the event and do not show up at the event, I acknowledge that I will not be allowed to attend the next event. If the behavior continues, I acknowledge that I will be evaluated on an individual basis and may have all event attendance privileges revoked. If there is a medical emergency that causes me/my family to miss an event and I am unable to notify the Amanda Hope team beforehand, I agree to advise the Amanda Hope team at the next available opportunity.

Rules of Conduct

By checking this box, I agree to conduct myself in a polite and respectful manner towards all other attendees, staff, volunteers, and any other individuals when attending an Amanda Hope Rainbow Angels event consistent with core values of the organization.

Confidentiality

The support group is a safe environment for families to support one another led by a facilitator. It is not group therapy. We respect people’s privacy and confidentiality. Everything said in the group should remain in the group. If at any time an participant presents with a statement of harm to self or others, the facilitator is required to report to appropriate entities to ensure safety of all parties.

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All caregivers who have lost a child to their battle with cancer or another life-threatening illness are invited to join us for a Bereavement Support Group led by Melissa, our Comfort and Care Counselor and Program Coordinator

register

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