Grief Group – Permission Form
2012 – 2013
Dear Parent/Guardian,
The Good Grief Club at Cabin John Middle School will be starting soon. Staff from Hospice Caring, Inc.
will partner with Cabin John to offer this free 7-session bereavement peer-support program. This group
supports children coping with the death of a loved one and will run on a rotating schedule once a week
for 40 minutes during the school day. Students will only miss one period per subject during the length
of the group.
Who is eligible for the group?


Any child who has experienced the death of a significant person in his/her life: parent, sibling,
grandparent, friend, or anyone else with whom the child was close.
The death could have occurred at any time – recently or years ago. (As children mature
cognitively, they sometimes revisit the loss and show signs of early grief again.)
If you have a questions or concerns, please do not hesitate to contact me 240-406-1560.
Warm Regards,
Mrs. Woodard
Counselor
Cabin John Middle School
Good Grief Club Permission Slip Form
PLEASE RETURN THIS FORM TO MRS. WOODARD IN THE COUNSELING OFFICE BY Monday, October 8th.
My child ______________________________ has my permission to participate in the 7-session Good
Grief Club at Cabin John Middle School. This club will be facilitated by Hospice Caring, Inc. staff and Mrs.
Woodard. I understand that my child may miss portions of his/her school work as a result of attending
this program. I also understand that my child will be responsible for making up any work missed.
Parent/Guardian
Signature_____________________________________________
Date______________
Name of person who died__________________________________________
Cause of death___________________________________________
Date of death___________________________________________
Relationship with student____________________________________
Death was: ______Sudden
______Expected
______Unexpected
Ways in which student has expressed grief:
Are there other concerns for your child on which you wish to comment?
_____________________________________________________________________________________