Registration Form

We will schedule a call following up with all registrants prior to them starting in the group.

First name *

Last name *

Email *

Address:

Area of Toronto:

Relationship to deceased:
Partner/Spouse
Parent
Sibling
Child
Grand Parent
Other Family Member
Friend

Time since death:
> 6 months
6 months - 2 years
> 2 years +

How the person died
Sudden
After an illness

How has grief impacted you (checkboxes – all that apply)
Mental
Physical
Spiritual
Social
Other

Any concerns or accommodations we should be aware of (checkboxes – all that apply)
Hearing
Vision
Mobility
Learning
Other