Healing Pathways EventsPlease enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Which upcoming event are you registering for? *Conversations with Caregivers – May 22 6:30-8:00pmFamily Movie Night – May 29 6:30-8:00pmDad’s Day Memories – June 12 6:30-8:00pmConversations with Caregivers – June 19 6:30-8:00pmFamily Fun Night (activity TBD) – June 26 6:30-8:00pmCaregiver InformationYour Name *FirstLastWhat is your relation to the children you will be registering? *Email *Phone *Are any additional adults attending with you? *YesNoIf yes, please list the adult's name and relation to the children. *Child InformationHow many children are you registering for this event? *Child 1 Name *FirstLastChild 1 Age *Child 1 Gender *SelectFemaleMaleNon-BinaryTransgenderPrefer Not to SayChild 2 Name *FirstLastChild 2 Age *Child 2 Gender *SelectFemaleMaleNon-BinaryTransgenderPrefer Not to SayChild 3 Name *FirstLastChild 3 Age *Child 3 Gender *SelectFemaleMaleNon-BinaryTransgenderPrefer Not to SayChild 4 Name *FirstLastChild 4 Age *Child 4 Gender *SelectFemaleMaleNon-BinaryTransgenderPrefer Not to SayChild 5 Name *FirstLastChild 5 Age *Child 5 Gender *SelectFemaleMaleNon-BinaryTransgenderPrefer Not to SayChild 6 Name *FirstLastChild 6 Age *Child 6 Gender *SelectFemaleMaleNon-BinaryTransgenderPrefer Not to SayAdditional InformationName of Deceased *FirstLastWhat was their relation to the children? *What was the cause of death? *Media ReleaseTo communicate Supporting Kidds’ mission and message, to educate the community about children and grief, and report program outcomes to funders, we often use quotations, stories, artwork, and photos for brochures, newsletters, lectures, training, newspaper articles, our website, and other forms of media. Last names and detailed information are omitted from these materials.I give permission for Supporting Kidds to use photos of my family for the purposes described above.YesNoI give permission for Supporting Kidds to use my family's artwork, quotations, and stories for the purposes described above.YesNoNext Steps…Have you completed a formal consultation with the Clinical Director for services at Supporting Kidds? *YesNoIf you have not completed a consultation, this form will take you to our Family Information Sheet after clicking “Submit” below.Please sign here to signify that you give your child permission to participate in Supporting Kidds groups and events: *Clear SignatureDate *Submit