Teens Group Registration - Inheritance of Hope

Are you between the ages of 13-18 and are facing the loss of a parent or have faced 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:
APPLICANT INFORMATION

First Name * Please provide the information. *

Last Name * Please provide the information. *

Date of Birth * Please provide the information. *

Relationship to Diagnosed Parent * 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. *

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

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

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.

Which applies to your family? *

My parent has been diagnosed with a life threatening illness.

-Diagnosis and how long your parent has been diagnosed:

My family has already experienced the loss of a loved one.

-Loved one's relationship to you
-Date of Death
Please provide the information. *

Parent/Guardian Info
(if applicable)

First Name Please provide the information. *

Last Name Please provide the information. *

Date of Birth Please provide the information. *

Relationship to Applicant Please provide the information. *

E-Mail Please provide the information. *

Phone Number Please provide the information. *

Same address as me

(If not, please provide information below)

Street Address Please provide the information. *

City Please provide the information. *

State Please provide the information. *

Zip Please provide the information. *

2nd Parent/Guardian Info
(if applicable)

First Name

Last Name

Date of Birth

Relationship to Applicant

E-Mail

Phone Number

Same address as me

(If not, please provide information below)

Street Address

City

State

Zip

Page 4:
Group Registration

Join other teens (ages 13-18) and our amazing Teen Team as we hangout on Zoom together! We will play games, share stories and have fun! This is an opportunity for Inheritance of Hope teens to make some new friends and connect with other teens who are walking a similar journey. All teens 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 *

Please provide the information. *

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 *

Please provide the information. *

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

CONNECT

Resources

GIVE