Family Nights

The Kemp Care Network provides a place for children, youth and their guardians to come together. Through participation in facilitated peer groups, they find understanding, stability and support.

Family Nights provide an opportunity for these families to meet others who have experienced loss, supported through group facilitation from KCN trained staff and volunteers. For questions, please contact Kathryn Turco BACYC. (OACYC), Child and Youth Counsellor on 905-387-2448 ext. 2205.

Please click here to register to the Family Nights or fill the form below.

Family Night Registration Form

Which session are you registering for?(Required)

If there is more than one session that you’d like to register for, please complete and submit this form for one session, and refresh the page to fill the form again.

Wed, Oct 22, Theme: Fears

Wed, Nov 19, Theme: Struggles

Wed, Dec 17, Theme: Connections

Wed, Jan 21, Theme: Comforts

Wed, Feb 18, Theme: Worries

Wed, Mar 18, Theme: Hopes/Dreams

Wed, Apr 22, Theme: Growth

Wed, May 20, Theme: Feelings

Name of guardian(Required)

First Last

Name of child/youth participant 1(Required)

First Last

Age of participant 1(Required)

Name of child/youth participant 2

First Last

Age of participant 2

Name of child/youth participant 3

First Last

Age of participant 3

Name of child/youth participant 4

First Last

Age of participant 4

Name of child/youth participant 5

First Last

Age of participant 5

Email(Required)

Phone Number(Required)

Address(Required)

Who has died & what was the relationship with the participant?(Required)

Comments/Additional Information

Consent(Required)

I agree and consent to the terms and conditions.

Bereavement Support Services
The Kemp Care Network is pleased to respond to your request for bereavement support services. Bereavement support services are designed to help you address your unique grief process. These services are provided free of charge. The role of the Bereavement Team is to assess the suitability for support of those seeking our services. If the Bereavement Team finds that someone’s needs are beyond the scope of bereavement support services, then the team will refer the individual to another appropriate service.

Volunteer Services
Some of the bereavement support services eg; groups, provided at the Kemp Care Network are facilitated by trained volunteers. Volunteers are trained to provide emotional support. At no time are they to be considered as professional therapists or grief counselors. Volunteers must report concerns to the SCMT and appropriate referrals will be made

Consent to Services:

Sharing of information
Non-identifying information about our service users may be shared for statistical or funding purposes. No information will be released to a third party without your written permission, except in cases where confidentiality is limited (see confidentiality section below). At any time, you have the right to withhold or withdraw consent, or place conditions on the disclosure of your information.

Collection of Information
Personal information is collected through registration form as well as communications with bereavement support services, and in some cases with trained Kemp Care Network volunteers. Communications include in-person or virtual sessions, telephone calls and messages, email and written correspondence. Files are secured in our electronic records are stored in a secure network that is password-protected. Client records are kept by the Kemp Care Network for 7 years.

Records
1. Information containing personal information, such as intake forms and progress notes, will be secured in locked cabinets and/or in encrypted programs.
2. Service user records are the property of the Kemp Care Network.

Access to Records
1. If you are an active service user, you can make an informal request to access your records through the Bereavement Team.
2. If you are no longer an active service user, you can make a written request to the Executive Director seeking to access your records. In your request, you must state the reason you would like to access your records.

Records that disclose information about a third party may not be shared. In addition, if the request to access them has been deemed vicious then the records may not be disclosed.

Modifications to records: Any comments on or disagreements with any documents in your records can be captured in a separate document and added to your file.

Confidentiality
Bereavement support involves sharing sensitive, personal, and private information. The bereavement support team is here to help you along your grief journey and will keep your information confidential. Bereavement support services are provided by a team, which may include social workers, music therapists, child and youth counsellors, and students/ volunteers under direct supervision of the Bereavement Team Manager. The team member providing you support may consult other members of the team to provide the best possible care.

Exceptions to Confidentiality
1. If we have information about or suspicion about abuse or risk of abuse to a child (under the age of 18years) then we have a duty to report this to the proper authority.
2. If there is evidence of clear and imminent danger of harm to self and/or others, we are legally required to report this information to the proper authority.
3. If we are required by law to release information, such as being subpoenaed to testify in court. While these events are rare, we would like to help you become aware that these possibilities do exist.

Our primary goal is to foster a safe space where you feel comfortable to explore and disclose personal concerns, stories, etc. If there are other limits of confidentiality in your situation, we will identify and discuss them with you as they arise.

Reasons for Dismissal from Services
We ask that you refrain from substance use of any kind on the day of your meeting, as it can have an impact on your participation in the session and may limit the effectiveness of the session. The Kemp Care Network will not tolerate harassment or violence toward staff, volunteers, service users and or any support providers.

Contacting Us
We appreciate prompt arrival for appointments, groups etc. Please notify us if you will be late or need to cancel. If you have any questions or concerns regarding bereavement support services, please contact the Bereavement Team. For child and youth services please contact Kat Turco Child and Youth Counsellor at (905) 387-2448 ext 2205 or by email at kturco@kemphospice.org.

By reading this I agree that myself, the ones I registered, and any others that may be participating during the night of the event have read and agree to the above statements.

Comments

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