Sign up Form
Maternal Grief & Liberation Support Group
Your Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Your Email
*
example@example.com
Gender identity and preferred pronouns
*
Ethnicity/Cultural Background?
*
What is your intention for joining our group?
*
Please choose the option that best describes you
*
I am a new mother (less than 3 years)
I am currently pregnant
I have been a mama for more than 3 years
I have been a mama for more than 7 years
How would you describe your take on collective liberation at this time?
*
How do you believe our roles as mothers to be intertwined with the liberation of marginalized and oppressed peoples?
Tell us a little bit about yourself and your motherhood journey
*
Do you currently work with a therapist and/or mentor?
*
Yes
No
Other
Have you ever received mental health support? Below, please provide as much information as you feel comfortable sharing with regards to your mental health history
*
Have you been a part of a group container previously? If so, please describe your experience; what were your likes and dislikes as to how the group was facilitated?
*
What are you looking for in a support group?
*
Are you willing to participate in all six sessions and commit to maintaining the privacy and confidentiality of other participants' shares?
*
Yes, I commit to showing up to my best ability and will maintain the privacy of others
I have questions
Not at this time
Please share a bit about your spiritual and/or religious beliefs. This will help me get to know the participants ahead of time as I prepare for the course curriculum, according to everyone's identities.
*
These group sessions will be largely informed by a decolonization framework, which stands by the dismantling of all systems of oppression and harm. This includes Palestine, Congo, Haiti, Sudan, occupied Indigenous territories, and beyond. Is this a framework that you are interested in partaking in, as it relates to our maternal experiences of grief and love?
*
Yes
I have questions
Not at this time
Do you have any other needs that can be supported by the facilitator and/or fellow group participants?
*
Do you have any physical, emotional, or other types of limitations that I should be aware of?
*
What attributes do you look for in a facilitator to help you feel safe and engaged in the process?
*
Please share your social media handles below (optional)
Save
Submit
Continue to Payment
Billing Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
My Products
*
prev
next
( X )
Online Support Group- 6 sessions
$
350.00
Payment Methods
Credit Card
Apple Pay
After submitting the form, you will be redirected to Apple Pay to complete the payment.
ACH Bank Transfer
Save
Submit
Should be Empty: