Grief Story Submission Form

You are warmly invited to share your story in your own way and at your own pace. There is no right or wrong way to express grief—only what feels true for you.

Your Name

(or write “Anonymous”)

Email Address

example@example.com

Who Are You Honouring?

(Name, relationship, or pet’s name if you wish)

Type of Loss

Optional – include a picture

Your Story (Share as much or as little as feels right)

You might choose to share a memory, what you miss, what grief feels like, or something you wish others understood.

Permission to Share (Multiple choice) How may your story be shared?

Name Display Preference If your story is shared, how would you like your name shown?

Follow-Up Contact? Would you like to be contacted about support services or groups?

Consent & Privacy
Your privacy and emotional safety are deeply respected. By submitting your story, you acknowledge and agree to the following:

Voluntary Sharing: Sharing your story is completely voluntary. You may choose how much or how little to share.
Use of Your Story: Based on your selection above, your story may be:
- Shared publicly (e.g., website or social media), or
- Shared anonymously, or
- Kept private for internal awareness only
You can request removal of your story at any time.
Confidentiality & Limits: While every effort is made to honour your privacy, please avoid including identifying details about others without their consent.
Storage of Information: Your information is collected and stored securely in accordance with Canadian privacy standards, including the Personal Information Protection and Electronic Documents Act (PIPEDA). Your information will not be sold or shared with third parties.
Not a Crisis or Clinical Service: This space is for sharing and connection. It is not monitored for crisis support or emergency response. If you are in immediate distress, please contact local emergency services or a crisis support line.
Emotional Wellbeing: Sharing your story may activate strong emotions. Please take care of yourself and seek support if needed.

Consent Agreement (Required Checkbox)