2026 YOU ARE NOT ALONE PEER LED CARE GIVER SUPPORT GROUP

REGISTRATION FORM
Welcome to the Christina Sullivan Foundation monthly Virtual and In-Person meetings for parents, caregivers and guardians to share experiences, resources. and gain support from other attendees. Meeting Time: 6:30PM - 8:00PM
Christina Sullivan Foundation Peer - Led Support Group Registration Form for Parents, Caregivers and Guardians "let's talk about it."
Mission Statement: To create a supportive community where parents, caregivers, and guardians can connect, share experiences, and find resources to navigate the challenges of caregiving, empowering them to improve their well-being and the quality of life for those they care for.
Please Welcome to the Christina Sullivan Foundation Family.
Director of YOU ARE NOT ALONE Jessica Lira. She is a social worker with nearly a decade of experience in advocacy, community engagement, and supporting underserved populations. She holds a Master of Social Work from the University of Houston and has worked across hospital and community settings, with a focus on serving veterans. A decorated disabled veteran who served overseas, Jessica brings both professional expertise and lived experience to her work.

Actively involved in organizations such as SERVE, ROSC, CAPGAL, Elks Lodge, and the Wounded Warrior Project, Jessica is passionate about strengthening communities. As a mother of six, including children with special needs, she offers a unique and powerful perspective on navigating ARD, IEP, and 504 processes—equipping families with the tools to advocate effectively for their children.

Jessica N. Lira, MSW

(706) 580 7978

Jessnlira@gmail.com

Sign-in
https://form.jotform.com/251283947746065

Another Nina Moment.
🦋all because she lived…
Next Meeting: Zoom and In-Person at the CSF Office. Address below

Wednesday, August 26, 2026

Meeting In-Person Address: Shearn Moody Plaza 123 25th Street, Suite 2017, Galveston, TX 77550

Virtual attendance provide your email and a link will be sent to you.
Vision to provide resource information, support, and advocacy for all caregiving concerns and to enhance the quality of life for all those affected by these concerns.
Core Caregiver Support Topics:

Self-Care & Emotional Health: Maintain and improve your physical, mental, and emotional well-being

Managing burnout: Overcoming caregiver guilt, dealing with anger, depression, loneliness, and maintaining personal wellness.

Practical & Daily Care Skills: Assistance with bathing, dressing, grooming, meal preparation, mobility, and transferring safely

Medical & Health Management: Medication management, coordinating with doctors, understanding diagnoses, and home safety improvements.

Legal & Financial Planning: Managing finances, navigating insurance, advance care planning, and estate issues.

Communication & Relationships: Setting boundaries, navigating family conflict, communicating with a person with dementia, and role reversal.

Support & Resources: Finding support groups, accessing respite care, long-distance caregiving, and preparing for the care receiver's end-of-life. Finding

Balance: Managing Stress: Spirituality Mental Health Physical Health

Family controversy: Conflicts with Parents/Siblings

Respite: A need for change

Did you really ask that: Handling inappropriate questions and responses from others

Anger: Ways to understand and control emotions

When to consider a facility or group home: Moving the care receiver to a care facility and being an advocate for them there
1.) Personal Information
Name

First NameLast Name
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState

Zip CodeCountry
Phone Number

Area CodePhone Number
2.) Information about the Person You Care For.
Name

First NameLast Name
Date Of Birth:
Description of Challenges:
Age:
Intrest and Hobbies:
Any specific needs or preferences for the support group?
3.) Support Group Preferences:
How did you hear about this support group? (e.g., word of mouth, social media, etc.)
What do you hope to gain from participating in this support group?
Are there any specific topics you'd like to see discussed in the group? (e.g., advocacy, transition to adulthood, etc.)
Is there anything we should be aware of regarding your comfort level or any sensitivities you might have?
Please share a topic you would like to discuss and learn from other attendees.
Mental Health, Physical Health, Financial Security, Spirituality, Intellectual Well-being and Social well being
4.) Consent and Confidentiality: I understand that all information shared in the support group will be kept confidential. I agree to abide by the rules and guidelines of the support group. I give my consent for my photo and information to be used for this purpose. All information protected through HIPPA (Health Insurance Portability and Accountability Act.)
Consent and Confidentiality:
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Wavier & Release
CONSENT

As the parent or guardian of the child/ren named above, I consent to my child/ren’s participation in The Christina Sullivan Foundation. I understand that The Christina Sullivan Foundation are program activities, and I agree that I (or another responsible adult whom I approve) will assist and supervise my child/ren. I understand that the organizers of The Christina Sullivan Foundation are not and will not be responsible for supervising my child/ren.

RELEASE AND INDEMNITY

I hereby release, discharge, and covenant not to sue The Christina Sullivan Foundation, the organizers of The Christina Sullivan Foundation, and their directors, officers, employees, agents, volunteers, representatives, owners, members, affiliates, successors, assigns and anyone associated with The Christina Sullivan Foundation (collectively, 'Released Parties'), from all liability to me, my child/ren, my and my child/ren’s personal representatives, assigns, heirs and next of kin, for any and all claims, demands, actions, complaints, suits, losses or damages on account of any injury to me or my child/ren, or in connection with my child/ren’s participation in The Christina Sullivan Foundation, including but not limited to personal injuries or property damage caused or alleged to be caused, in whole or in part, by the negligence of the Released Parties or otherwise.

If, despite this release, I, my child/ren, or my child/ren’s personal representatives, assigns, heirs or next of kin make a claim against any of the Released Parties named above, I agree to indemnify, defend and hold harmless the Released Parties from any litigation expenses, attorney fees, loss, liability, damage, or cost incurred due to such claim.

Furthermore, I agree to release, indemnify, defend and hold harmless the Released Parties from and against any and all claims, demands, actions, complaints, suits, losses, damages or other forms of liability that any of them may sustain arising out of my child/ren’s failure to comply with applicable laws or arising out of any damage or injury caused by me or my child/ren in connection with participation in The Christina Sullivan Foundation.

I HAVE READ THIS PARENTAL CONSENT, UNDERSTAND THAT BY AGREEING I GIVE UP SUBSTANTIAL RIGHTS THAT I AND/OR MY CHILD/REN WOULD OTHERWISE HAVE TO RECOVER DAMAGES FOR LOSSES OCCASIONED BY THE RELEASED PARTIES’ FAULT, AND SIGN IT VOLUNTARILY AND WITHOUT INDUCEMENT. I ALSO CONFIRM THAT I AM THE PARENT OR LEGAL GUARDIAN OF THE CHILD/REN NAMED ABOVE.

PHOTOGRAPHY DISCLAIMER

I hereby grant The Christina Sullivan Foundation permission to make still photographs, video recordings, audio recordings and other recordings of me and/or my child/ren and/or to use my name and/or my child/ren’s name and/or my likeness and/or my child/ren’s likeness and/or verbal quotes from me and/or my child/ren (“Authorized Materials”) and to reproduce and distribute the Authorized Materials in or across any media. I also give The Christina Sullivan Foundation permission to use the completed Authorized Materials, and to use my or my child/ren’s name and likeness for The Christina Sullivan Foundation promotional and commercial purposes without compensation. I waive the right to review materials produced by The Christina Sullivan Foundation, including those using my or my child/ren’s name and likeness.

Furthermore, I relinquish and grant to The Christina Sullivan Foundation all rights, title and interest in and to the Authorized Materials that I and/or my child/ren may have, including but not limited to completed still photographs, video tapes, audio recordings, negatives, prints, reproductions, duplicates and verbal quotes for print. I will not object to or take any adverse action against The Christina Sullivan Foundation for use, reproduction, or distribution of such Authorized Materials.
Signature
Should be Empty:

REGISTRATION FORM

Welcome to the Christina Sullivan Foundation monthly Virtual and In-Person meetings for parents, caregivers and guardians to share experiences, resources. and gain support from other attendees. Meeting Time: 6:30PM - 8:00PM

Christina Sullivan Foundation Peer - Led Support Group Registration Form for Parents, Caregivers and Guardians "let's talk about it."

Vision to provide resource information, support, and advocacy for all caregiving concerns and to enhance the quality of life for all those affected by these concerns.

1.) Personal Information

2.) Information about the Person You Care For.

3.) Support Group Preferences:

Wavier & Release