Virtual Adult Bereavement Open/Drop-In Support Program Registration

The Virtual Adult Bereavement Open/Drop-in Support Group is specifically for adults 18+, for any type of loss and at any point in your grief journey.

Offered on select Monday evenings, 7pm - 9pm.

You are welcome to attend all 4 of the scheduled group support sessions or only the ones that you are able to or interested in attending.

May 15th, 2023
May 29th, 2023
June 12th, 2023
June 26th, 2023

Please complete and submit this registration form in order to participate in BFO-SCR's Virtual Adult Open/Drop-In Grief Support Group. All information submitted will remain private and strictly confidential.

If you have any questions or concerns, please call 905-318-0070 or email programming@bfoscr.com.

You will receive an email with the Zoom link the morning of each support group session including the support group information.

**Registration made after 4pm on the same day of the group cannot guarantee participation.**

Name*

First NameLast Name

Please share your pronouns

optional

Email*

example@example.com

Phone Number*

Please enter a valid phone number.Format: (000) 000-0000.

Address*

Street Address

Street Address Line 2

CityProvince

Postal CodeCountry

Emergency Contact*

First NameLast Name

Emergency Contact Phone Number*

Please enter a valid phone number.Format: (000) 000-0000.

Yes, I understaned

Group Guidelines:

Please try your hardest to be available on time. The group format works best if everyone comes at the scheduled time. If you know that you will be late, please email programming@bfoscr.com or call 905- 318-0070 ahead of time.
Please remove outside distractions, silence cell phones and turn off unrelated electronics.
Please refrain from consuming alcohol or substance use prior to and during support group sessions.
Own your feelings and experiences. In support groups the use of "you" may be interpreted as offering advice or an interpretation of someone else's experiences. Stay within the "I" position.
Remember to share the floor.
Respect is an integral part of each group. Please respect other's opinions, emotions, and experiences.
Please respect the privacy of the group participants by joining the support group in a private space. The use of earbuds or headphones are recommended.

Confidentiality:

Group participants should not describe anything discussed in group with others outside of group. You may share with others your own contributions to the discussion, but not what others have shared, or any details about other members, including their names, appearance or any other related personal information.
I have been advised that Bereaved Families of Ontario South Central Region will make every attempt to respect my privacy and boundaries. I understand that Bereaved Families of Ontario South Central Region cannot guarantee strict confidentiality.
I understand that Bereaved Families of Ontario South Central Region will use a third-party video conferencing solution to facilitate the virtual support group meetings. Although these calls may be encrypted for protection from malicious eavesdropping, Bereaved Families of Ontario South Central Region cannot guarantee this. By participating in the call, each member has reviewed and accepted the security of the facilitating platform.
Members are forbidden from recording group sessions in any way. Personal confidential notes are okay.
If you see other group members out in public, please be respectful of their boundaries as some people would like to remain anonymous in the community.
Facilitators are not required to share personal contact information.
The group leader cannot reveal information about me without my written permission except where disclosure is required by law:
- Anyone who indicated they wish to harm themselves or others
- If there are suspicions of abuse of a minor
- If there are suspected sexual abuse against anyone by a regulated health professional

Self-Care in Emergencies:

I acknowledge and understand that the grief support group facilitators are not medically trained counsellors or therapists, but offer peer-to-peer support.
I acknowledge that it is my responsibility to my personal and mental health to seek out medical care or any other assistance which I require.
If at any time I feel overwhelmed and I want to leave the group or feel like harming myself or injuring another, I will let the group leaders know and contact my individual therapist, grief counsellor or psychiatrist. If I cannot reach them, I will call COAST 905-972-8338, or Crisis Services Canada/Talk Suicide, Toll-free 1-833-456-4566 or 911 or go to the nearest hospital emergency room.

Yes, I understand

This electronic signature represents my understanding and consent to the terms, conditions and guidelines above:*

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