Maternal Group for Grief & Liberation Part II

Your Name*

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Your Email*

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Gender identity and preferred pronouns*

What is your vocation?

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 pregnantI have been a mama for more than 3 yearsI 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?*

YesNoOther

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 othersI have questionsNot 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?*

YesI have questionsNot 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?*

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Billing Address*

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My Products*

Online Support Group- 7 sessions

$750.00

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Total

$0.00

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