Couples Workshop | St. Joseph, Rayne, LA | Saturday, November 9, 2024

Couple's Information

Name

Spouse Name

This address will receive a confirmation email

Phone

Address

Please list any food allergies or medical concerns we need to know about?

Diocese:

Parish Name:

Child's Information

Choose your loss category. If you have more than one loss, please choose the group that you would like to be in.

Miscarriage (conception to 19 weeks) Stillbirth (20+ weeks) Infant Loss (birth to 1-year-old) Child Loss (2 to 9 years old) Adolescent Loss (10 to 20 years old) Adult Child Loss (21+ years old)

Child's Name

Date of Birth

Date of Death

Age of Your Child. - If your loss is before birth, please place number of weeks here. We will know it's in utero based on the loss category.

Additional Losses

Payment

Registration is free, but donations will be gladly accepted to offset the cost. Please give what your family can. The suggested donation is $100 per family. Thank you!

Choose an amount

Disclaimer

Upon obtaining the appropriate releases, Red Bird Ministries, Inc. (RBMI) may share testimonies and stories of familiese of loss, and anyone utilizing RBMI's resources shall indemnify and hold harmless RBMI in their efforts to support those grieving families.

RBMI's support seeks to accompany grieving families in the trenches of their grief but is not intended to replace traditional therapy.

RBMI does not provide online or in-person counseling or therapeutic services for a fee. Any gift or donation received directly offsets operational and program development expenses to fund these resources. If you require counseling, please contact a licensed mental health provider in your area.

I agree and consent to the above statement and will hold harmless Red Bird Ministries in their efforts to accompany grieving families.

Yes, I agree.

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Couples Workshop | St. Joseph, Rayne, LA | Saturday, November 9, 2024

Description

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