HOPE Group Registration

Sometimes our light goes out, but is blown again into instant flame by an encounter with another human being. Each of us owes the deepest thanks to those who have rekindled this inner light.
Dr. Albert Schweitzer

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Date

H.O.P.E. Group - Personal Information

First Name* Last Name* Age* Home Address* City* Zip Code* Phone No.* Email* Verify Email

Second Person

Is someone accompanying you? Yes No Maybe

First Child

Name* Age* Cause of Death* Date of Death*

Second Child

Name Age Cause of Death Date of Death

Other Information

What other group(s) have you participated in? Which counselor(s) have you seen? What else will be helpful for me to know about you? How did you find out about the group?