REGISTRATION FOR TRAINING
Print out and send this completed form and deposit to
KIDS HURT TOO, P.O. Box 11260, Honolulu, HI 96828
or fax to 545-5683 or email the information required to kidshurttoo@hawaiiantel.net

Name

Address

City

State

Zip

Phone (home)

(work)

Email

Occupation/Title

Employer

Employer Address

Signature

Date

Dates, times, and location of training vary depending on the size of the group. To learn more call 545-5683.

       Enclosed is my non-refundable deposit of $25.

       Enclosed is my full $75 course fee. I understand that $50 is refundable if cancellation is made two weeks before the first session begins.

       Put me on your list for when a training session becomes available.

       I want to take the training but cannot volunteer. I am willing to pay the professional fee of $250.

Please note that volunteer facilitators/mentors are required to attend all three days of the training. Kids hurt too reserves the right to accept or reject all potential volunteers. Participation in the reduced rate training indicates that you intend to commit to one year of volunteer facilitating and mentoring with children, teens, or care givers in a peer support group. Volunteering for a peer support group is an eight hour a month commitment. If you want to know about future training, please sign up for our email newsletter at our website: www.kidshurttoo.org.

CAUTION! This training can be very intense. It involves a willingness to explore your personal experience of grief and loss. When scheduled to attend, please make sure that you have free time after training for self-care. We are committed to the well being of our volunteers as much as our families. The training also includes 1) history and current model on children’s grief; 2) facilitating grief through play; 3) facilitating groups; 4) creating a safe environment for healing. This is an experiential, practice oriented training.

PLEASE COMPLETE THE REGISTRATION QUESTIONNAIRE

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

Describe any training you have had related to grief or group facilitation.

Does your experience include a loss from death, divorce, or separation from a parent? If so, when and give a short summary of your experience.

What reason do you have for wanting to be a children's grief support and mentor volunteer?