Welcome to Calm Waters' Virtual Student Support Group Registration

The mission of Calm Waters is supported by grant funding and individual donations. Most grantors request demographic information about Calm Waters participants, such as age, gender, race and income. This grant funding allows Calm Waters to continuously provide FREE grief support services to children and families in their grief journey caused by death, divorce or other significant loss. 

Thank you for your assistance and participation.

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* 3. Parent/Guardian Information

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* 4. Additional Email

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* 5. Child Name

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* 6. Child Gender

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* 7. Child Age

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* 8. Name of your child's school?

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* 9. Please check all losses that your child has experienced, currently or previously.

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* 10. Do any of the below apply to your household?

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* 11. Have you or a family member been a victim of one of the following crimes? (Select all that apply.)

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* 12. Annual Family Income

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* 13. Child Ethnicity: Please select all that apply.

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* 14. How did you hear about Calm Waters' Center for Children and Families School Support Groups?

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* 15. Pre-Virtual Student Support Group Survey Questions.
Once your child's virtual support group is complete, Calm Waters will email you a post-group survey, allowing us to see the improvement your child has made and to consider potential updates to our curriculum. 

In the past two weeks:

How often has your child felt irritable or anxious?

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* 16. How has your child been sleeping?

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* 17. How has your child been eating?

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* 18. How has your child’s energy been?

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* 19. How would you rate your child’s overall health?

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* 20. How would you rate your child's overall happiness?

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* 21. Has your child experienced bodily pain? (For example, stomachaches, headaches).

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* 22. Has your child been using substances like alcohol or drugs?

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* 23. Has your child felt alone with their loss?

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* 24. How well is your child able to verbally identify and communicate their feelings to you?

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* 25. When faced with a stressful or difficult situation my child adapts well.

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* 26. When faced with a stressful or difficult situation, my child has skills to cope.

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* 27. The below questions represent the Adverse Childhood Experiences (ACEs) Quiz, when you see the word "you" read it as if your child was taking the quiz.

Did a parent or other adult in the household often or very often… Swear at you, insult you, put you down, or humiliate you? or Act in a way that made you afraid that you might be physically hurt?

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* 28. Did a parent or other adult in the household often or very often… Push, grab, slap, or throw something at you? or Ever hit you so hard that you had marks or were injured?

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* 29. Did an adult or person at least 5 years older than you ever… Touch or fondle you or have you touch their body in a sexual way? or Attempt or actually have oral, anal, or vaginal intercourse with you?

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* 30. Did you often or very often feel that … No one in your family loved you or thought you were important or special? or Your family didn’t look out for each other, feel close to each other, or support each other?

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* 31. Did you often or very often feel that … You didn’t have enough to eat, had to wear dirty clothes, and had no one to protect you? or Your parents were too drunk or high to take care of you or take you to the doctor if you needed it?

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* 32. Were your parents ever separated or divorced?

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* 33. Was your mother or stepmother:
Often or very often pushed, grabbed, slapped, or had something thrown at her? or Sometimes, often, or very often kicked, bitten, hit with a fist, or hit with something hard? or Ever repeatedly hit over at least a few minutes or threatened with a gun or knife?

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* 34. Did you live with anyone who was a problem drinker or alcoholic, or who used street drugs?

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* 35. Was a household member depressed or mentally ill, or did a household member attempt suicide?

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* 36. Did a household member go to prison?

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* 37. I understand that my child will be joining a Calm Waters Virtual Student Support group. I understand that this is a support group and not a counseling group. I understand that this group is led by trained volunteers and attendance in this group is optional.*

If you consent for your child to attend this support group, please type your full legal name. 
*If you are a School Counselor or School Facilitator you can only sign your name with a physical copy of the guardians consent.

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