Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Please complete this form to sign up for a retreat or other service. Doing so will help ensure you get the most out of the activities in which you're engaged. First and last name *Email address *Phone number *Tell me a little about yourself. *Tell me about your loss(es). How long ago did they occur? *Have you ever worked with a coach before? If so, please tell me a little about that experience. Tell me how I can help you. *Do you have family or other supportive relationships? Tell me a little about how you’re being supported. *If you're involved in counseling sessions or under regular care of a physician, please give basic details. *Do you have any health issues I need to be aware of? Food or other allergies? *Is there anything I need to be aware of to improve accessibility, such as mobility or hearing needs? Gatherings at The Loss Art take place on site in Port Dover, Ontario. Please indicate if you have any concerns about attending in person.What type of service are you most interested in? *2-day retreat1-day workshop1/2-day workshop at my location1/2-day workshop at your location6 weekly sessionsOne-on-one coachingPlanning a ritualLegacy projectWhich workshop would you like to attend in Spring 2024? *Grieve a job loss – Wednesday, March 27Grieve your job loss and reimagine your future – Friday, April 12 (full day)Honour and re-member your loved one – Thursday, April 18Reimagine your future – Friday, April 26Honour and re-member your loved one – Friday, May 10Re-member your loved one and reimagine your future – Friday, May 31 (full day)If you’re available to attend on more than one date, you may indicate your preference when you speak to Julie.How did you hear about The Loss Art? *Do I have your consent to contact you by phone? *Yes, during the dayYes, in the early eveningNoSubmit
