Jovonne's Healing Center (Kids)

Jovonne's Healing Center for Kids

Monthly In-Person Meetings
Jovonne’s Healing Center for Kids is an in-person program welcoming children dealing with many forms of loss—whether due to the death of a loved one, separation from a caregiver, or other significant life changes. Each month, we host a one-hour session featuring a fun, thoughtfully planned activity designed to aid in their healing process. We also offer occasional off-site experiences, giving children a chance to simply enjoy being kids.

Sessions take place every third Wednesday of the month at 4:00 p.m. at ACCESS: Chester Community Center, 701 Booth Street, Chester, PA 19013. If you feel your child could benefit from this supportive environment, please fill out the form below. We look forward to offering hope and comfort through shared experiences and connection.
Parent/Guardian Name*

First NameLast Name
Child Name (Please complete form for each individual child)*

First NameLast Name
Age of Child*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian E-mail Address*
example@example.com
Primary Contact Number*
Format: (000) 000-0000.
Can we send text messages?*

YesNo
Emergency Contact Name*

First NameLast Name
Emergency Contact Phone Number *
Format: (000) 000-0000.
Race/Ethnicity*

African AmericanHispanicNative AmericanMiddle EasternNative Hawaiian/Other Pacific IslanderAsianCaucasianOther
What is your household income range? (Optional, for grant funding purposes)

$0 - $25,000$25,001 - $50,000$50,001 - $75,000$75,001 - $100,000$100,001+Prefer not to say
Do you and/or your child have any experience with counseling in a group setting?*

YesNo
What concerns, if any, do you have about your child attending this program?
Bereavement History
Name of person lost*
Relationship to person lost*
Date of Loss:*
Cause of Loss:*
Does your child have memories of the person lost?*

YesNo
Do you and others talk about the person lost?*

YesNo
Do you and others talk about the person lost?*

YesNo
Has your child experienced the loss of additional people?*

YesNo
Has your child received any professional support? (Support group, psychologist, school counseling)*

YesNo
Describe the majority of your child's memories of the person lost:*

All Positive MemoriesMostly Positive MemoriesMostly Negative MemoriesAll Negative Memories
How did you learn about Jovonne's Healing Center?

Past participantThe Trippley Foundation's Facebook pageA Trippley Foundation Board MemberThe Trippley Foundation's Instagram pageThe Trippley Foundation's newsletterThe Trippley Foundation's LinkedIn pageFamily member and/or friendSchoolAnother organizationOther
Do you have any comments or questions?
Should be Empty:

Jovonne's Healing Center for Kids