New Member Registration Form 2017-06-21T13:54:02+00:00

If you are a new member, please fill out the form below to register for any of our programming.

Last name:

First Name:

Email Address:

Address:

Home Phone Number:

Do you want to be added to our email distribution list and receive our newsletter and upcoming program information?

Select the program(s) you want to register to
Finding HOPE Support GroupMaking TRaCS Support GroupLegacy Academy

Have you participated in a Grief and Bereavement support group? Please check the box beside yes or no. YesNo
If you selected yes, please list the group(s) name and location you attended:

Spouse/Partner Information

Last Name:

First Name:

Birthdate (mm/dd/yyyy):

Date of Death (mm/dd/yyyy):

Cause of Death:

Children Information

List your children's names and ages below.

Please state any concerns or further information we should know.

Peer Based Mutual Support

Information and supports offered by The Hummingbird Centre for HOPE (HCH) are provided in a peer-based environment. We do not offer professional counselling.

Peer support means that experiences are shared by individuals whose spouse or partner has died and are now in a place in their journey to give back. As a result of their loss, they are “experts” at their own grief and are ready to share the knowledge they have learned through their grief journey. The power of peer support is that it can create a sense of normalcy by engaging with others who are experiencing the same multitude of reactions. All volunteers have been trained in accordance with the centre’s mission and mandate.

The topics included in support will help to provide tools, knowledge, courage and strength needed to create a new sense of self for individuals as they work to rebuild and maintain a new quality of life for their young family.


Confidentiality

The Hummingbird Centre for HOPE (HCH) values and respects your privacy. All personal information we receive will be kept confidential within our organization according to all legal requirements. We do not share any information outside HCH. Staff and volunteers within HCH will have access to your personal information as needed. Your information will be used to provide you with opportunities for continued support and to keep you updated of all activities within HCH. If you wish to be removed from our contact list, please contact us at marny@hummingbirdcentreforhope.com

HCH does not offer counselling services. For professional advice and counselling, please contact your family doctor, professional counsellor or other mental wellness professionals.

Please check the box if you give permission for the Hummingbird Centre for Hope (HCH) to share the above information with their staff and volunteers who are directly involved in the support program for which you are registering for. If you understand that HCH offers peer support programs and does not offer professional counselling. Also if you have read the HCH "Peer Based/Mutual Support & Confidentiality Statement above"