Stepping Stones Grief Support Program Enrollment

Caregiver Information (parent or guardian)

Bereavement Information

Child/Teen Information

Other Family Information

Policies & Consent for Participation

I, the undersigned parent (or guardian) of the child/teen named above (hereinafter referred to as “child”), give my consent for the child’s participation in Bridges programming.

EMERGENCY CARE RELEASE: I authorize, that in an emergency situation, Bridges personnel/school staff to call emergency services. In the event that I cannot be reached or be present, I hearby authorize Bridges personnel/school staff to execute any and all documents including any necessary releases in my behalf which might be required by any medical facility to perform any emergency care on account of an accident or illness sustained or incurred by the child while participating in Bridges’ programming. I further agree that in consideration of my child participation in Bridges’ programming, I will hold Bridges for End-of-Life personnel/school staff harmless from any action by me, my child, or family members on account of any injury or damage sustained or suffered by my child while attending Bridges’ programming, and hereby waive any right of legal action against Bridges for End-of-Life.

MANDATORY REPORTING: Bridges’ staff and volunteers will maintain all confidentiality when working with children. However, South Carolina law does require that any of us report suspected cases of abuse or neglect to ensure the safety of our community’s children. A report must happen if a volunteer or staff member has any reason to believe that a child’s physical or mental health has been, or may be, adversely affected by abuse or neglect. By signing below, you acknowledge you have read and agree to all items listed above.

By 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.

Family Grief Survey

Next Steps: Schedule a Orientation with our Program Staff

If you choose not to schedule a call now, you will have an link to schedule in your confirmation email. Orientation call must be complete prior to attendance to any of our programs. Thank you!