FAMILY GRIEF WORKSHOP FORMS

Thank you for your interest in attending a Family Grief Workshop hosted by the Healing Patch Children's Grief Program. The workshop is an opportunity for your family to engage in meaningful activities, many of which are arts and crafts based to help with the grief process. 

The next workshop will be held on Sunday, August 24th from 1:00 - 3:30 p.m. at the UPMC Outpatient Building, 152 Zeman Dr., Ebensburg. Space is limited. Please pre-register before completing the forms below by contacting Healing Patch staff Melody Ray at This email address is being protected from spambots. You need JavaScript enabled to view it. or (814) 947-7200.

Prior to completing the workshop application/authorization, we ask that you please review the following agreements. Completing the application is acknowledgement that you have reviewed and agree to the agreements below.

1. A caregiver is required to attend the workshop with the child(ren) and is responsible for the supervision of the child(ren).
2. We will respect the confidentiality of the other grief workshop members' information that is shared. 
3. If any family members' behaviors are disruptive to the grief workshop process, I understand we may be asked to leave. 
4. I understand that the workshop is not therapy or counseling and will be led by a grief professional and trained volunteers. 

Please take a moment to complete the forms below.

Family Grief Workshop Application 

Consent for Photos* | Print Version (If preferred, please print and bring completed form with you.)
*Each adult attending the group must complete a separate Consent for Photos authorization. Child(ren) need to be reflected in only one form.