OCEANS - GRIEF AND LOSS PEER SUPPORT PROGRAMME Child EnrolmentFinding hope and healing after loss starts here. Complete the form (online or download the PDF) below. Download Enrolment Form Enrol OnlineStep 1 of 333%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 PhoneChild's / Children's DetailsChild's / Children's Details Child's NameActions EditDelete There are no Children. Add Child Maximum number of children reached. Session Times & LocationPlease select your preferred day/s for the weekly meeting1st Choice*Any day suitsMondayTuesdayWednesdayThursdayFriday2nd ChoiceAny day suitsMondayTuesdayWednesdayThursdayFriday3rd ChoiceAny day suitsMondayTuesdayWednesdayThursdayFridayPreferred time to meetChoose one4:00pm-5:00pm4:30pm-5:30pmDuring school hoursPrederred LocationSelect LocationAshburtonGeraldineTemukaTimaruWaimateOnline (Zoom)OtherLocation DetailsPlease provide further location details.Child pick up & collectionIf 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 PhoneName First Last PhoneConsent & AgreementConsent & 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.