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“Open your arms to life! Let it strut into your heart in all its messy glory!”
–Deborah Wiles
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Monthly Group Night Registration
Monthly Group Night Registration
Monday September 12, 2022 • 6:30 PM
Please fill out this form to register for our upcoming group night.
Group Night Registration
Monthly Group Night Registration
Yes, I have attended these groups before
I have already spoken with a Heartlinks Clinician about attending
I'm attending Aching Arms/Compassionate Friends group only
If you have not attended a monthly group night or spoken with one of our Clinicians about attending, you MUST call our office at (618) 277-1800 or fill out the new client form on our website before registering.
Today's Date
*
MM slash DD slash YYYY
What's your name? (First & Last)
*
Email
*
Which groups are you registering for this month?
*
Aching Arms / Compassionate Friends (Child Loss Group)
Partner Loss / Parenting Alone
Ducks / Teens
Rhap (Pre-Teens & Younger Teens)
Stars (Older Elementary age students)
Bears (Younger Kids-Early Elementary Age)
Include all groups your family will be attending.
Please list the names of all children attending and which group they will attend or type N/A
*
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COVID-19
I agree that I will not attend group if anyone in my party has been experiencing COVID-like symptoms or has received a positive COVID test in the last 14 days.