JOURNEY Grief and Loss Consent Form

Dear Parent,

St. Peter will be offering a JOURNEY support group for students who are experiencing feelings of grief or loss due to the painful transition of the loss of a loved one. Areas of loss may include death, divorce, separation, or terminally-ill family members. The group will meet after the school day for 8 sessions.  If your child would like to continue with the JOURNEY support  group, another 8 sessions will be offered beginning in the Spring. Group will meet on Thursday afternoons beginning on November 16 from 2:30-3:15PM in the small chapel.

This group will provide your child with the opportunity to share his or her feelings in a group setting, among his or her peers. . Students process grief through games, drama, art, journaling, and story-telling. Through this support group, we hope to assist your child in expressing his or her own feelings, to feel acceptance about what has happened, and to feel a sense of belonging. We will accomplish this through the channels of peer support, a nurturing adult to guide them, and a secure place to share a part of themselves.  

If you would like your child to participate in this group, please complete the bottom portion of this form and you will receive a confirmation email from me stating that your child is enrolled in our group. Please keep in mind, this support group is not intended to be a substitute for individual or family counseling. If you are looking for additional services, we have family and individual counseling which is provided by St. Peter staff, and we also have a list of referrals for organizations, private practices, and therapy programs which might provide further assistance.  If you would like further information or have any questions, please do not hesitate to contact me at  (847)259-4114 ext. 196 or at  

In God’s Peace,

Lexi Schmidt

Student’s Name

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* 1. Student’s Name

Student's Age

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* 2. Student's Age

Type of Loss

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* 3. Type of Loss

Parent's Signature and Name

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* 4. Parent's Signature and Name

Where should your child go after JOURNEY?

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* 5. Where should your child go after JOURNEY?

Any additional information you would like Miss Schmidt to know...

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* 6. Any additional information you would like Miss Schmidt to know...

Please provide a parent phone number

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* 7. Please provide a parent phone number

Please provide a parent email

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* 8. Please provide a parent email