Bereavement Café

Welcome to the Bereavement Café initiative, coordinated by the Galway Hospice Bereavement Service.

This is a free service which is open to all adults who have experienced a bereavement, not just those who have used the services of the Hospice previously.

The Bereavement Café is not a counselling service, it is a space to avail of mutual support and understanding in your experience of grief.

Please complete this registration form if you are interested in attending.

Bereavement Café Registration

Name(Required)

First Last

Email(Required)

Enter Email Confirm Email

Phone Number(Required)

Address(Required)

Date of Birth(Required)

Month you wish to attend the Bereavement Cafe(Required)

We would like to hold your contact details (which are your ‘Personal Data’) on our files for the duration of time that you may wish to avail of our support services. We will keep your Personal Data safe, secure and confidential. Anyone with whom we share your Personal Data will also be bound by the same obligations of confidentiality. We require your permission to contact you in relation to future Bereavement Café initiative/events/evaluation of our service. Do you consent to the above:(Required)

Yes

We ask you to read the following statements and tick each box that you consent to(Required)

Galway Hospice can contact me on my mobile to inform me of future Bereavement Café events

Galway Hospice can send me e-mails to inform me of future Bereavement Café events

Do you have any questions or comments?

Bereavement Café Registration

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