REGISTRATION: Grief and Youth

Register for the Grief and Youth Workshop

Complete the form below to register a student between ages 12-14. Thank you!

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Name

First

Last

Preferred Pronouns

Phone Number

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Age

Date of Birth yyyy/mm/dd

School

Can you commit to attending the group on April 4, 11, 18, 25, and May 2, and 9?

What are you hoping to gain from participating in this group?

Will your parent/caregiver be attending the Zoom Meet and Greet?

See you soon!

Starting Thursday, April 4, 2023 from 3:30pm to 5:00pm

A FREE 6 week group for ages 12-14

Presented by Hospice Dufferin & Dufferin Child and Family Services

Registration is limited. A representative will be in touch to confirm your participation.