Peer Grief Support Groups Waitlist Group : Waitlist Are you a current client of The Grief Club? * Yes No First Name * Last Name * Email * Phone Who is your primary counselor? * Cara Mearns-ThompsonSarah KroenkeAllison ChantEmily BrocadoLindsay Butzer Young Adult Are you between the age of 18-25? * Yes No Name of person who died * Relationship to person who died * ParentSiblingOther Relationship to person who died Cause of death * AccidentHealth/MedicalOverdoseSuicideOther Cause of death Date of death * Donuts Teen Name of child attending group * Age of child attending group * Grade of child attending group * 9101112 Name of person who died * Relationship of child to person who died * ParentSiblingOther Relationship of child to person who died Cause of death * AccidentHealth/MedicalOverdoseSuicideOther Cause of death Date of death * Young Widow/Widower Do you have children aged 25 or under? * Yes No Name of person who died * Cause of death * AccidentHealth/MedicalOverdoseSuicideOther Cause of death Date of death * Death of a Child Name of child who died * Cause of death * AccidentHealth/MedicalOverdoseSuicideOther Cause of death Date of death * Overdose Group Name of child who died * Date of death * Join Waitlist If you are human, leave this field blank.
