Registration Form

Send this completed form along with the questionnaire and deposit to:

Kids hurt too, 245 N. Kukui ST., STE 203, Honolulu, HI 96817 or

Fax to: 545-5683 or email the information requested to [email protected]

Volunteer Children’s Grief Facilitation and Mentor Training Registration Form



Date of Birth




City: State:                           Zip:
Phone (H): Phone (W):
Cell: Email:
Occupation/Title: Employer:

Matching Grants Program:      Yes              No

Employer Address:
City: State:  HI           Zip:
Training dates for which you are registering: For more information visit our web

       Enclosed is my non-refundable deposit of $25.

       Enclosed is the full $125 training fee. $75 of this is refundable if cancellation is made two weeks before the first               session begins.

       I am interested in receiving a sponsorship for the cost of training. Please indicate how much you can contribute             to the training fee. $___________.

     I am not interested in volunteering and will pay the fee of $550.


Please note that to receive a certificate you are required to attend all hours of the training. Kids hurt too reserves the right to accept or reject all potential volunteers.



Signature                                                                                                   Date



Volunteer Children’s Grief Facilitation and Mentor Training

Registration Questionnaire

1.          Please tell us why you are interested in attending this training.




2.         Describe any training you have had related to grief management.




3.         Does your experience include the loss of a family member or loved one through death, divorce, and/or separation?  If so, how recently and please give a short summary of your experience, stating how, when, and who?




4.         What do you hope to gain as a result of attending this training?



5.         Is there anything that might prevent you from making a one year commitment of 8 hours a month to volunteer with a children’s grief support group? If so, please explain on the back if you need more space.


*This training can be very intense. It may be the first time you work on your own grief in a support group setting. You are advised to not plan social activities on the evenings after training, giving time for rest and processing your experience. When working with children and teens in a support group, you are a role model, communicating hope and nurturing the spirits of children in the crisis of loss with unconditional love. This training is essential to learning how to communicate unconditional acceptance of grief in yourself and in others. You will receive a reminder notice and the location prior to training.