Rainbow Kids Winter Series Registration

The Rainbow Kids program will be held at Family Connections for children 5-18 years of age and adults grieving a loss. We will try to offer 2 different groups for adults. Children are grouped by age.
Please contact me with questions or concerns.
Terri Schultz
(920) 904.8529

Question Title

* 1. Parent/Caregivers Information/Informacion de Padre/Cuidador

Question Title

* 2. List the name and age of each child attending the series
Indique el nombre y la edad de cada niño que asiste a la serie.

Question Title

* 3. Please indicate their loss.
Por favor indique la perdida.

Question Title

* 4. Any medical information you would like to share or other information use this box.
Cualquier informacion medica que desee compartir u otra informacion utilice este cuadro.

Question Title

* 5. I would like to join the adult group.
Me gustaria unirme al grupo de adultos.

Question Title

* 6. Please indicate your loss.
Por favor indique la perdida.

T