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*

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.

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Masks Required

I understand that masks are required at group night, regardless of vaccination status. I agree to wear a mask at group night, unless instructed otherwise by a Heartlinks counselor.

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