Volunteer Information

Teen Group (8-week Session) Registration

Tuesdays, September 10 - October 29, 2024

6:30 - 8:00pm

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 that 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

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 and as a part of that support, New Hope provides follow-up communication via phone and/or email.

B) Online and In Person groups will be led by 2 adult facilitators. Facilitators are not licensed counselors.

C) All topics discussed are confidential and kept within the group. We ask the teenager to enter the online group in a private area due to the confidential nature of the conversation in the group.

D) If the teen or parent/legal guardian is interested, we are happy to provide the names of outside licensed counselors. We are not endorsing any particular counselor.

E) We are a mandated report agency and as such are required to disclose to the proper authorities. If a teenage participant discloses, that they are considering harm to oneself or another, the parent or legal guardian will be immediately notified.

F) Online groups are conducted via common video conferencing platforms. We do not guarantee that they are private or HIPPA compliant.

G) We take precautions to protect your identity. New Hope does not record any of the online or in-person sessions. New Hope does not sell or distribute group member personal information. I, as a participant, agree not to record, screenshot, or share any portion of any group session.

H) 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 teen's participation in the event or involvement in any capacity. Further, the participant and the parent/guardian release and promise to indemnify, defend, and hold harmless New Hope Center for Grief Support for any injury arising directly or indirectly out of the registered activity.

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 for marketing purposes.