Contact Us

We’d love to help your child start their healing process......

Child's first name*

Child's last name*

Child's birthday*

Month

Day

Year

Parent/Guardian Name*

Phone

School name*

Grade Level

Child involved in DCS or Probation

DCS

Probation

N/A

DCS/Probation Officer Name/ Email/ Contact Phone Number (we can provide updates to show your child/children participation)

Do you have transportation?

Yes

Are you aware this group is an eight-week program starting 08/18/26. 5pm - 6:30pm Est. You are committing to making sure your child attends all sessions to get the most benefit out of the program.

Yes

Is your child aware you are signing them up for this program and willing to participate?

Yes

At times Identity Outreach will capture real conversation, take pictures, or videos. Soley up to the parent/guardian/child discretion to share any vulnerable info. The purpose is to spread awareness to grief and loss. Do you consent to media?

Yes

Date

Month

Day

Year

Parent/Guardian Signature

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If you have any questions, please feel free to reach out via. email admin@identityoutreach.org or phone 888-553-5325.