Bereavement Support Group Inquiry Form • St. Hilary Church

First Name *

Last Name *

Preferred Name *

Email Address *

Mobile Number *

Name of Deceased Person *

When did the person pass away?

What is your relationship to the person who passed away? *

Would you prefer to attend our:

Six-Week Bereavement Support (intended for those with a recent loss)

Ongoing Monthly Support (intended for those seeking to rebuild their lives after experiencing a loss some time ago)

I would like to attend:

In-Person

Through Zoom

Is there anything else we should know to serve you better?