Volunteer Information

Teen Group Summer Sessions Registration

Tuesdays, June 25, July 19 & 23, August 6, 2024

6:30 - 7:30pm

This group will meet in person at the New Hope Office - 133 W. Main Street, Suite 113, Northville, MI 48167.

Part of our Circles of Hope program. Teen group is an 8-week session support group designed for teens who are grieving the death of a loved one. This program will help teens better understand their grief, provide a safe space for them to communicate their thoughts and feelings, and provide them with healthy coping skills, and the tools they will need to help them navigate their grief journey.

Teens must have parent/guardian permission to register. This form is to be completed by the teen and a parent or guardian together. If there is more than one teen in your family who wishes to attend the teen group, please fill out a separate form for each teenager.

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

Teen Contact Information - Please complete a separate form for each teen attending Teen Group

First Name

Last Name

What are your preferred pronouns?

Birthdate

Address

Address 2

City

State/Province

Zip/Postal Code

Do Not Send Mail

Main Phone

School district

What grade are you currently in?

Relationship of loss (e.g. mother, father, sibling, grandparent, etc)

Name of the person who died

Date of the loss

Was this a sudden loss?

Please enter any other information you'd like New Hope to be aware of- cause of death, specific relationship, etc.

Please list any other significant losses your family has had in the past 5 years:

Parent/Caregiver Contact Information

Parent/Caregiver First Name

Parent/Caregiver Last Name

Parent/Caregiver Main Phone

Parent/Caregiver Email

Address

Address 2

City

State

Zip

Emergency Contact Name

Emergency Contact Phone

2nd Emergency Contact

Phone

Terms & Conditions - Please Read Below

Please type teenager's electronic signature to indicate that you agree to the terms and conditions below:

Today's Date

Please type parent/guardian's electronic signature to indicate that you agree to the terms and conditions below

Today's Date

Submit

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.

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Terms/Conditions
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