Volunteer Information

First Time Participant Form

2024

* Required Fields

Contact Information

First Name

Last Name

Address

Address 2

City

State/Province

Zip/Postal Code

Main Phone

Cell Phone

Birthdate

Age Group

Gender

MaleFemale

* Gender is required.

Please complete the following information for an Emergency Contact if you agree for New Hope to contact this person should it be needed.

Emergency Contact Name

Emergency Contact Phone Number

Loss Info

Please check program you are attending today

Have you attended a New Hope Program in the past? Check all that apply

8 Week Workshop

Beginning the Grief Journey Seminar

Holiday Seminar

First Steps

Type of Loss

Date of the loss

Loved One's Name

Do you have grade school children at home?

Please provide name(s) and age(s) of child/children.

Support Info

What do you hope to achieve by attending a grief support group?

How did you learn about New Hope?

Terms and Conditions

By entering your name here you agree to the terms & conditions specified at the bottom

Date

TERMS & CONDITIONS:

I have voluntarily provided the above information which is true and correct to the best of my knowledge.

I understand that:
a). the services provided by the staff and volunteers of New Hope Center for Grief Support are strictly support services and not professional counseling; b). as a part of that support, New Hope may provide follow-up communication via phone and/or email.

Photo Release
I agree to allow New Hope Center for Grief Support to use my and/or my child(ren) photographs and video footage on their website and other promotional documents from this event as they see fit.

Hold Harmless
I agree to hold harmless the host location of this event, New Hope Center for Grief Support, their employees, volunteers, officers, and directors from any claim or action that may arise from my own or my child(ren) participation in the event or involvement in any capacity.