Disability/Chronic Illness Peer-Led Online Grief Support Group Registration
Tuesday, January 20th at 7 PM Central ~ Link provided to registrants week of group
Please note:
This is a peer-led group and not a chaplain-led group. Meeting link will be provided to registrants on the day of the meeting via your preferred form of communication. ***IF YOU HAVE NOT RECEIVED DETAILS BY 6 PM Central on January 20th, PLEASE CHECK YOUR TEXT AND EMAIL SPAM FOLDERS.*** If you have questions about any element of this registration form, feel free to text the peer facilitator for the group at 615 669 8062. (There may be a slow response time, but they will get back to you.)
Name
First Name
Last Name
Pronouns
Email
example@example.com
Phone Number
Please enter a valid phone number.
Signal number or username (if available, feel free to provide in lieu of cell number)
Preferred method of communication
Email
Text
Signal
If this group were to be held at other times in the future, which days/times would work for your schedule? (Select all options that work for you.)
Monday mornings
Monday evenings
Tuesday mornings
Tuesday evenings
Thursday evenings
Friday mornings
Friday evenings
Saturday mornings
Saturday evenings
Sunday mornings
Sunday evenings
Other
How did you hear about this group?
Disclaimer: I understand that this is a peer-based and Peer-Led, secular grief support group and is not therapy or a substitute for therapy or other mental health services. (Affirming mental health resource information provided by request.) Participation in the event is by registration only and is exclusively for LGBTQIA+ participants with disabilities and/or chronic illness, age 18+. For safety and privacy, I will not share the meeting link publicly or privately with others without facilitator permission. I understand that group space is limited and my participation is not guaranteed. I will follow any and all group participation guidelines for the safety and well-being of myself and others and will alert the peer facilitator if there are any concerns.
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