Formularz zapisowy: Praca z ciałem dla osób w żałobie - Dom Ukojenia | Grief House Warsaw

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1About you

2Accessibility and your needs

First name *

Enter your first name

Email *

Enter your email address so we can send you details of the meeting

Phone number

Enter your phone number (optional). This helps us reach you if there are last-minute organisational changes

Are you 18 or older? *

At the moment, Dom Ukojenia meetings are for adults

Which of the following dates would you like to register for now? *

14 March 2026 (reserve list)
18 April 2026
16 May 2026

Please register for one selected workshop date

Which language do you feel most comfortable speaking? *

in Polish
in English

The bodywork sessions are conducted in Polish, with the option of English interpretation

What kind of loss have you experienced? *

death of partner / spouse
death of a child
death of another close family member
death of a friend / another important person not related to me
multiple loss (the death of several close people within a short period of time)
perinatal loss
loss of a companion animal
other

If you’ve experienced more than one type of loss, choose the one that feels hardest right now. If it’s not listed, you can write it in

When did this loss happen (approximately)? *

3 months to 1 year ago
1 year to 2 years ago
more than 2 years ago

The session is intended for people whose loss happened at least 3 months ago.

What do you need most right now? *

space to express sadness
a place where I can cry freely
space to express anger
help with coping with emotions
being among people who understand what I’m going through
releasing tension in the body
other

You can choose more than one answer

Would you like to write a few sentences about the story you’re coming with? (optional)

If you’d like, you can share a bit more about your situation

Your current situation

The questions below may feel difficult, but they are important. We don’t judge your answers — they help us make sure this form of support is enough for you at this moment

Are you currently receiving specialist assistance? *

I do not currently use
I am in individual/group therapy
I use a psychiatrist
I am in therapy and under the care of a psychiatrist
I use another form of assistance

Receiving specialist support does not exclude participation in the meetings. If you are in therapy or under psychiatric care, it would be good to consult your participation with your specialist.

How often in the last 2 weeks have you had thoughts that life has no meaning or that it’s not worth living? *

almost all the time
often (several times a day)
sometimes (a few times a week)
rarely
not at all

In the last 2 weeks, have there been moments when you felt relief from these difficult thoughts or could imagine a future? *

yes, I do have moments like that
no, the difficult thoughts are with me all the time
I’m not sure

Which of the following best describes how you are feeling right now?

sometimes I think others would be better off without me, but I’m not planning to harm myself
I think about death, but not about hurting myself
I have thoughts about taking my own life, but I don’t have a specific plan
I have thoughts about taking my own life and I’m considering specific ways
I don’t want to answer this question

Thank you for responding/responding so honestly. Your answers are a very important signal.

Grief House Warsaw meetings are peer-to-peer, community-based support, not crisis intervention — this is why we can’t register you for the meeting at this time. This doesn’t mean you are alone. Right now, you may need more direct support.

You can take advantage of the 24-hour, free assistance:

Direct support for people in mental health crisis 800 70 2222
Helpline for children and young people 116 111
Bereavement support from the Suddenly Alone Foundation 800 108 108 (Mon-Fri, 14:00-20:00)
Konsultacje online dla osób w kryzysie – zwjr.pl (Fundacja Życie Warte Jest Rozmowy)

Accessibility and your needs

We want Grief House Warsaw meetings to be as accessible and welcoming as possible. The questions below are completely optional — answer only the ones that matter to you.

What is important for you regarding the space and moving around?

step-free entrance / elevator access
other (add details at the end of the questionnaire)
I don’t have any specific needs in this area

How do you feel physically? What should we know? *

I experience chronic pain
I have mobility limitation
I get physically tired easily
I prefer not to be touched
I need frequent breaks
I don’t have any specific needs in this area
I prefer to talk about this at the beginning of the session
I am allergic to essential oils

są się? komunikacji?

Do you need any specific communication support?

interpretation into English
interpretation into Polish Sign Language (PJM)
I don’t have any specific needs in this area

The bodywork sessions are conducted in Polish, with the option of English interpretation

Will you need to come to the session with a child?

Due to the nature of the session (bodywork requires focus and freedom of movement), we prefer participants to attend without children. In exceptional situations, we will contact you individually.

Are there any other important needs we should know about before the meeting?

We may not be able to meet every need, but we’ll do our best to adapt the space and the way the meeting is run.

Consent and ground rules

Have you read the Grief House Warsaw meeting rules and do you accept them? *

Yes, I know the rules and I agree to follow them

The rules are available at the bottom of this page: https://griefhouse.community/en/nasze-spotkania/

I understand that Grief House Warsaw meetings: *

are a space for peer-to-peer, community-based support — not psychotherapy
do not replace medical help or crisis intervention
if needed, the organisers may suggest a different support pathway than taking part in the group

Do you consent to the processing of your personal data so we can contact you and register you for the meeting you selected? *

Have you read the privacy policy and do you accept it? *

The privacy policy is available here: https://griefhouse.community/en/polityka-prywatnosci/