OCEANS - GRIEF AND LOSS PEER SUPPORT PROGRAMME

Child Enrolment

Finding hope and healing after loss starts here.
Complete the form (online or download the PDF) below.

Download Enrolment Form

Enrol Online

Step 1 of 3

Parent/Caregiver - Main Contact
(ie. The person filling this form in.)
Parent/Care Givers Name*
First Last
Contact Phone*
Email Address*
Address
Street Address City Postcode
Other Parent/Caregiver's Name
(Fill our as appropriate)
Alternative Phone

Child's Name	Actions

There are no Children.

Child pick up & collection
If your child is to be collected by any other person not listed below it's very important to notify the Co-ordinator. Please complete name and phone number of people you approve to collect your child/ren

If your child is to be collected by any other person not listed below it very important to notify the Co-ordinator.
Name
First Last
Phone
Name
First Last
Phone
Consent & Agreement
Consent & Agreement*
I consent and agree to the following.
I understand and agree that the Oceans Grief and Loss programme is supported by Christchurch City Mission:
• Will treat my information with security by the programme coordinator and only share information with programme facilitators to enhance the relevancy and support of the programme.
• The City Mission will retain clients’ personal information no longer than it is required for the purposes for which the information was collected.
• May use my information in a way that does not identify me for statistical or audit purposes.
• Cannot guarantee confidentiality when my personal safety, the safety of others or the safety of the participant are in question.

I can request at any time:
• To view information the Oceans Grief and Loss programme holds about me.
• To give feedback on Oceans Grief and Loss programme services.
To assist in covering the cost of the OCEANS Programme and to confirm your attendance, we would appreciate a payment of $20.00 per child
Our ANZ bank account number is: 06-0831-0007713-51

By submitting this form, you agree to proceed with an enrolment into an Oceans group. An email of confirmation will be sent to you.

OCEANS - GRIEF AND LOSS PEER SUPPORT PROGRAMME

Child Enrolment

Enrol Online

Step 1 of 3

Parent/Caregiver - Main Contact

Child's / Children's Details

Session Times & Location

Child pick up & collection

Consent & Agreement

Please tell us about your child's/children's loss.