Register for Healing Waters Session PLEASE COMPLETE THE FORM BELOW Name * First Name Last Name Phone (###) ### #### Email * Session Date * Add which Healing Waters session you'd like to attend. MM DD YYYY Tell us about your loss * Abortion Stillborn Infant Loss If you've experienced infant loss, what age was your infant? * 0-3 months 4-6 months 7-9 months 10-12 months If you've experienced a miscarriage, what trimester were you? * 1st trimester 2nd trimester 3rd trimester What would you like to gain from this support group? * Please share the contact information of anyone else that would benefit from this support group. (Name, phone number, and email) Thank you! Return to events
