Consent for Grief Support Services
Please read this form. Ask questions about anything that you do not understand before you sign.
Grief support services are facilitated by Grief Trained individuals who have gone through a grief training process with Bereavement and Grief Specialists. Grief Trained individuals possess diverse backgrounds and may include teachers, counselors, social workers, police officers, and nurses.
Benefits of grief support services may include the following:
I understand and/or agree to the following:
Risks and Privacy Considerations:
In consideration of my or my child’s participation in the activity listed above, I (and my child, if I am signing as parent or guardian) release Children's Hospital and Health System, Inc. and its affiliated entities, and their respective officers, directors, employees, agents and volunteers (“Children’s”) from any and all liability or claim for loss, injury or illness that my child may sustain during my child's participation in this activity. I understand that this release applies to myself (or my child) and my (or my child's) personal representatives, heirs and assigns, and that this release excludes any harm or loss caused intentionally or recklessly by Children’s. I (and my child, if I am signing as parent or guardian) also waive the right I (or my child) have to bargain for different release of liability terms.
I have read this information. I am legally able to consent for myself or my child. By checking the box above, I give my permission and agree to the terms.