Family Friday

Finding Your Superpowers Registration

Friday, October 18, 2024

5:30 - 7:30 pm

Location: Plymouth First United Methodist Church, 45201 N. Territorial Road, Plymouth, MI 48170

Part of our Circles of Hope program that provides a family-centered approach to grief support by investing in children, supporting parents, and strengthening the family. Finding Your Superpowers is an interactive family event designed to help families respond to grief and loss through the stories of our favorite superheroes. Ages: 4-14

Due to the generosity of grantors, donors, and sponsors, New Hope is able to provide our programming resources to participants at no cost. In order to help us steward our resources, please note, if you have registered, but are no longer able to attend, please contact our office by noon the day prior of the program or event.

You can contact us at 248-348-0115 or email us at [email protected].

* Required Fields

Parent/Caregiver Contact Information

First Name

Last Name

Address

Address 2

City

State/Province

Zip/Postal Code

Main Phone

Birthdate

Relationship of loss to yourself (e.g. spouse, child, parent, etc.)

Are you registering as a DHD (Detroit Health Department) referral?

YesNo

* Are you registering as a DHD (Detroit Health Department) referral? is required.

Child Participant Information- Please complete for each child attending Family Friday

Name of Child 1 (Include First and Last)

Date of birth for Child 1

Name of Child 2 (Include First and Last)

Date of birth for Child 2

Name of Child 3 (Include First and Last)

Date of birth for Child 3

Name of Child 4 (Include First and Last)

Date of birth for Child 4

Name of Child 5 (Include First and Last)

Date of birth for Child 5

Relationship of Loss to Child

Date of the loss

Has everyone listed attended a Circles of Hope or New Hope program before?

YesNo

* Has everyone listed attended a Circles of Hope or New Hope program before? is required.

Additional Information about your child's loss

Submit

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.