Peer-Led LGBTQIA+ Grief Support Group Registration
Monday, September 14th at 5:30 PM Central ~ Location provided to registrants the day of the group
Please note:
This is an in-person peer-led group and not a chaplain-led group. Meeting location will be provided to registrants on the day of the meeting via your preferred form of communication. ***IF YOU HAVE NOT RECEIVED DETAILS BY 4 PM Central on September 14th, 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.
Format: (000) 000-0000.
Signal number or username (if available, feel free to provide in lieu of cell number)
Preferred method of communication
Email
Text
Signal
How did you hear about this group?
Schedule a brief, pre-session check-in call with the peer facilitator
*
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, age 18+. For safety and privacy, I will not share the meeting location 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.
*
Continue
Continue
Should be Empty: