Program registration form REGISTRATION IS CURRENTLY CLOSED contact us if you have any questions about our programs! Choose which program you'd like to register for: If you are registering for the workshop, would you like to attend virtually or in person? Virtually In-Person Date of Birth Type of Loss - Select one option from the dropdown: Spouse Parent Child Adult Child Significant Other Ext. Family / Friend Sibling Other If you selected extended family/friend or other, please let us know your relationship to the person you lost below. Date Loved One Passed Was the loss due to suicide? Yes No Was the loss due to overdose or substance abuse? Yes No Do you have school-aged children? Yes No Are you interested in learning more about our summer two-day Kids Camp? Yes No Send