Stepping Stones Enrollment Pre-Evaluation Building bridges of hope for lowcountry families since 1980 Please enable JavaScript in your browser to complete this form.Caregiver Information (parent or guardian)Name *FirstLastBereavement InformationWhat is the Deceased relationship to Child? *Mother/Step-MotherFather/Step-FatherBrotherSisterGrandparentExtended Family (Aunt, Cousin, etc.)FriendOtherDate of DeathType of Death *Illness/DiseaseAccidentSuicideHomicideOverdoseNaturalUndeterminedPrefer Not to AnswerOtherChild/Teen InformationChild/Teen Name *FirstLastChild/Teen makes goals for the future *NeverSometimesAlwaysNot SureChild/Teen speaks openly about their feelings and emotions *NeverSometimesAlwaysNot SureChild/Teen asks questions about the death or deceased *NeverSometimesAlwaysNot SureChild/Teen displays unhealthy coping skills *NeverSometimesAlwaysNot SureChild/Teen reaches out to people when they need to talk *NeverSometimesAlwaysNot SureChild/Teen shares stories/memories of the deceased *NeverSometimesAlwaysNot SureDo you have second child/teen to enroll?YesNoSection DividerSecond Child/TeenSecond Child Name *FirstLastChild/Teen speaks openly about their feelings and emotions *NeverSometimesAlwaysNot SureChild/Teen asks questions about the death or deceased *NeverSometimesAlwaysNot SureChild/Teen makes goals for the future *NeverSometimesAlwaysNot SureChild/Teen reaches out to people when they need to talk *NeverSometimesAlwaysNot SureChild/Teen displays unhealthy coping skills *NeverSometimesAlwaysNot SureChild/Teen shares stories/memories of the deceased *NeverSometimesAlwaysNot SureDo you have third child/teen to enroll?YesNoThird Child/TeenThird Child Name *FirstLastChild/Teen shares stories/memories of the deceased *NeverSometimesAlwaysNot SureChild/Teen makes goals for the future *NeverSometimesAlwaysNot SureChild/Teen speaks openly about their feelings and emotions *NeverSometimesAlwaysNot SureChild/Teen asks questions about the death or deceased *NeverSometimesAlwaysNot SureChild/Teen reaches out to people when they need to talk *NeverSometimesAlwaysNot SureChild/Teen displays unhealthy coping skills *NeverSometimesAlwaysNot SureDo you have a fourth child/teen ? YesNoFourth Child/Teen InformationFourth Child Name *FirstLastChild/Teen speaks openly about their feelings and emotions *NeverSometimesAlwaysNot SureChild/Teen displays unhealthy coping skills *NeverSometimesAlwaysNot SureChild/Teen shares stories/memories of the deceased (copy) *NeverSometimesAlwaysNot SureChild/Teen makes goals for the future (copy) *NeverSometimesAlwaysNot SureChild/Teen asks questions about the death or deceased (copy) *NeverSometimesAlwaysNot SureChild/Teen reaches out to people when they need to talk *NeverSometimesAlwaysNot SureDo you have a fifth child/teen ?YesNoFifth Child/Teen InformationFifth Child Name *FirstLastChild/Teen speaks openly about their feelings and emotions (copy) *NeverSometimesAlwaysNot SureChild/Teen displays unhealthy coping skills (copy) *NeverSometimesAlwaysNot SureChild/Teen reaches out to people when they need to talk (copy) *NeverSometimesAlwaysNot SureChild/Teen shares stories/memories of the deceased *NeverSometimesAlwaysNot SureChild/Teen asks questions about the death or deceased *NeverSometimesAlwaysNot SureChild/Teen makes goals for the future *NeverSometimesAlwaysNot SureNotes or any additional explanation or observances:Section DividerPolicies & Consent for ParticipationBy entering your name below, you acknowledge that everything on this application is correct and you want to move forward with processing your family's enrollment to the Stepping Stones Grief Support Program.Submit Get Started Enroll Complete the Stepping Stones Membership Form Schedule Schedule time with our staff to discuss your needs & our support l Register Sign-up to attend one of our activities or events