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(302) 235-5544

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support@supportingkidds.org

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Supporting Kidds Family Information and Consent Form (Schools)

Supporting Kidds Family Information & Consent Form (Schools)
Supporting Kidds, the Center for Grieving Children and Their Families, is providing grief support groups in schools throughout the state of Delaware. Please complete the following information and consent form to permit your child to participate in the school based program. Please complete this form separately for each child.

Child & Family Information

This information is utilized by Supporting Kidds when applying for grants, funding, and aid. All identifying information is kept confidential.
Child's Name
Please provide the name of your child’s school.
Child's Gender
Child's Race/Ethnicity

Deceased Information

Example: Parent, sibling, aunt, uncle, cousin, grandparent, etc.
Example: Cancer, heart disease, overdose, COVID-19, lung disease, murder, suicide, accident etc.
Does the child know the cause of death?
Drag & Drop Files, Choose Files to Upload You can upload up to 4 files.
Please provide a photo (or multiple photos if applicable) of the deceased for a surprise, personalized gift that each child will receive at the end of the group session.

Parent/Guardian Information

Parent/Guardian Name
Example: Parent, sibling, aunt, uncle, cousin, grandparent, etc.
Home Address
By signing below, I confirm that I have read and understand the information provided above and voluntarily give permission for my child to participate in the Supporting Kidds School-Based Grief Support Program.
Clear Signature
Future Supporting Kidds Events – Supporting Kidds offers community events and programs for grieving children and families throughout the year.