Remembering You: Sharing Our Stories Sibling Event

Remembering You:
Sharing Our Sibling Stories

A time set apart for teens and adults who have experienced sibling loss to share their journey; what life has been since the death of their sibling, how their sibling’s life and death impacted their own lives, and when sibling loss happens what has helped.

This will be an opportunity to share our grief and hope journey stories and the love we have for our siblings.  (Ages 13-99 welcome)

The event will be held on May 11, 2019 from 8:30 AM to 1:00 PM.

First United Methodist Church
503 N Central Expy
Richardson, TX 75080

Please complete and send the online registration form below.

If the form does not send, please email us with the information to info@teammercy.org.

Remembering You: Sharing Our Stories Sibling Event Registration. Please fill out this form to enable us to plan accordingly for this special time together. We look forward to seeing you

Registrant Name: (required):

Mailing Address:

Telephone:

Your Email (required):

Your Age: (Minimum Age 13)

Additional Participant Name: Age (Minimum Age 13): Email:

Additional Participant Name: Age (Minimum Age 13): Email:

Additional Participant Name: Age (Minimum Age 13): Email:

Additional Participant Name: Age (Minimum Age 13): Email:

I am sharing a sibling story of:

Date of Birth:

Date of Death:

Waiver/Disclaimer:

I understand the Remembering You event is a community sharing event for those who grieve a similar loss hosted by TeamMercy.org, Children’s Hospital, and First United Methodist Church Richardson, TX. This event does not constitute, nor substitute for licensed professional medical, psychological, psychiatric, social work, or pastoral care. (Yes answer is required) Yes

Media Release:

By selecting the "Yes" box below I (the registrant), grant permission to TeamMercy.org, Children’s Hospital, FUMCR, hereinafter known as the “Hosts” to use my image and the images (photographs and/or video) of the above named children listed as additional participants above (if any) for use in Hosts Publications including: Video, Email Blasts, Brochures, Newsletters, General Publications, Websites and/or Affiliates and other similar non-profit related publications I hearby waive any right to inspect or approve the finished photographs or electronic matter that may be used in conjunction with them now or in the future, whether that is known to me or unknown, and I waive any rights to royalties or compensation arising from or related to the use of the image.

I am at least 20 years of age or older and/or I am the parent or legal guardian of the above named children listed as additional participants (if any). I am competent to contract in my own name and contract for the children. I have read this release before checking the yes box below , and I fully understand the contents, meaning and impact of this release. I understand that I am free to address any specific questions regarding this release by submitting those questions in writing prior to signing, and I agree that my failure to do so will be interpreted as a free and knowledgeable acceptance of the terms of this release.

(Required)
Date: (Required)