Register

To become a member of Healing Household 6 support groups and caregiver program please fill out the form below and attach the required document:

Fields marked * are required.
Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Phone*
Email*
Emergency Contact Name*
First Last
Emergency Contact Phone*
Support Group
- General Caregiver Support
- Widow Support
- DV, Divorce, & Separation Support
- Healing the Homefront
- Life After Caregiving
* Please upload your documentation file. File types accepted are PDF, Microsoft Word .doc/.docx*
Accepted file types: pdf, doc, docx, Max. file size: 256 MB.
Caregivers registering must attach one of the following: Caregiver Stipend Letter, Veteran’s Benefit Letter, or signed letter from a partner organization (WWP, The Independence Fund, Code of Support, or Military Veteran Caregiver Network/Red Cross). DD214 or Military ID will NOT be accepted as proof of veteran affiliation. Additional documentation may be required for programs.

register