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Monthly Group Night Registration

March 6 • 6:30 PM

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*