Support Registration

SUPPORT REGISTRATION FORM

Welcome to the Still A Mum support group registration. Still A Mum is a charity that supports all parents dealing with child loss

Structure of the support groups: WhatsApp groups are run the same way as the physical groups to make sure everyone benefits equally. As such we will have 5 sessions. The counselor will engage us in these sessions. We usually have 3 days between sessions on WhatsApp and meet once a week for physical groups to give everyone a chance to contribute
A few house rules for the group sessions:

1. Approach your healing deliberately. Contribute in the sessions. The material is designed by several counselors so it is good and helpful. However you need to participate and engage. Answer questions. Ask.

2. Each group should stay focused on the purpose of the group. Kindly no forwards or “sent as received” messages unless the information is relevant here. Relevant information is that which encourages and builds up.

3. Confidentiality – women need to share without reservation. Because of that no screenshot will be taken in the WhatsApp group sessions. You can’t share someone’s story in your circles. The group session -both physical and online are SAFE SPACES so let’s keep it that way.

4. Respect – Still A Mum does not discriminate against tribe, marital status or even religion. As such I request us to be respectful in our interactions. Steer clear of sharing things that can be offensive.

Now, the groups are open to men and women of all ages and backgrounds. To be able to serve you better we need some information. For example you may have lost your baby at 14 weeks while another may have lost a 2 year old child. Putting you in a relevant group will enable the counselor to serve you better and hence improve your healing process.

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SUPPORT GROUP REGISTRATION

PLEASE FILL OUT THE FORM BELOW

YOUR NAME

YOUR PHONE NUMBER

YOUR EMAIL ADDRESS

GENDER

HOW OLD ARE YOU?

MARITAL STATUS

OCCUPATION

AT WHAT POINT DID YOU LOSE YOUR BABY?

WHERE DO YOU LIVE? PLEASE INDICATE THE TOWN/CITY AND COUNTRY

HOW LONG HAS IT BEEN SINCE YOU LOST YOUR BABY?

AT WHICH STAGE ARE YOU IN YOUR GRIEF?

WHICH SUPPORT GROUP DO YOU WANT TO BE IN? ALL GROUPS ARE RUN BY A COUNSELLOR

HOW DID YOU HEAR ABOUT STILL A MUM?

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