Kids: Life After Loss Group Registration

Are you registering kid(s) between the ages of 7-12 years old who experienced the loss of a parent?

Yes

Please provide the information. *

This group is not the best fit for you at this time.
Please feel free to explore our other Hope@Home™ Group options and reach out to
Allie@InheritanceOfHope.org
if you have any questions.

Page 1:
PARENT/GUARDIAN INFORMATION

First Name * Please provide the information. *

Last Name * Please provide the information. *

Date of Birth * Please provide the information. *

Relationship to Kids * Please provide the information. *

E-Mail * Please provide the information. *

Phone Number * Please provide the information. *

Street Address * Please provide the information. *

City * Please provide the information. *

State * Please provide the information. *

Zip * Please provide the information. *

Page 2:
FAMILY INFORMATION

Our mission is to inspire hope in young families, with children 18 or under,
facing the loss of a parent to a life-threatening illness.

When did the diagnosed parent pass away?* Please provide the information. *

Diagnosis: Date of Death:

Have you/your family utilized/participated in any other services with Inheritance of Hope?
If so, which ones?
(Check all that apply)

Legacy Retreat®

Hope@Home™ Weekend

Annual Legacy Event

Hope@Home™ Group

Hope@Home™ App

How did you hear about Inheritance of Hope? * Please provide the information. *

Page 3:
KIDS INFORMATION

1st Child's Name * Please provide the information. *

1st Child's Birth Date * Please provide the information. *

1st Child's Relationship to Parent * Please select an option. *

Comments (any special needs, difficulty coping, etc.)

2nd Child's Name

2nd Child's Birth Date

2nd Child's Relationship to Parent

Comments (any special needs, difficulty coping, etc.)

3rd Child's Name

3rd Child's Birth Date

3rd Child's Relationship to Parent

Comments (any special needs, difficulty coping, etc.)

If you have more than 3 children, please enter their info below.

Page 4:
Group Registration

Join other kids (ages 7-12) and our amazing Kids Team as we hangout on Zoom together! We will play games, share stories and have fun! This is an opportunity for Inheritance of Hope kids to make some new friends and connect with other kids who are walking a similar journey. All kids are welcome!

What is one word (or a phrase) that would describe how you/your family are currently coping? * Please provide the information. *

What do you hope to gain by attending a Hope@Home™ Group? * Please provide the information. *

Any other information that would be helpful for our group facilitators to know about how we can best come alongside you? (optional)

Page 5:
ACKNOWLEDGEMENTS

I understand the purpose of Hope@Home™ Groups is to encourage a confidential and safe place for connection and shared experiences. The purpose of groups is not to provide counseling or therapy, but rather offer support through resources and relationships.

I agree *

You must agree to the term. *

By registering for this group, I give permission to Inheritance of Hope to photograph, film, and/or record and use those materials to encourage more people to enjoy this valuable resource.

I agree *

You must agree to the term. *

Inheritance of Hope trained volunteers may contact me directly to offer encouragement and on-going support outside of group meetings.

I agree (Optional)

Please provide the information. *

Programs

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Resources

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