Formularz zapisowy: Migrant Grief Circle - Dom Ukojenia | Grief House Warsaw

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1About you

2Accessibility and your needs

We want Grief House Warsaw meetings to be as accessible and welcoming as possible. These questions help us prepare the space and the way the group is facilitated, and make sure this format will feel safe and supportive for you.

Please remember that Grief House Warsaw is a form of community-based, peer-to-peer support — companioning, non-judgemental, based on conversation and being together. These meetings are not psychotherapy or crisis intervention.

Answering these questions is required in order to register. All of your answers are confidential.

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 language do you feel most comfortable speaking? *

in Polish
українською мовою
in English

Select the language you feel most comfortable communicating in

Is it OK for you to take part in a meeting held in English? *

Yes, English works for me
No, I can’t manage in English
I need language support

You don’t have to speak “perfect” English. It’s enough to be able to listen to others and share what you’re going through or feeling.

Select a language:

interpretation into Polish
interpretation into Ukrainian
another language (which one?)

What kind of loss have you experienced? *

death of a close loved one
death of another person important to me
loss of country, language, and traditions
loss of a sense of safety/security
oss of a profession, career, or social role
significant loss of health (your own or a loved one’s)
loss of a companion animal
multiple loss or perinatal loss
several of the above at the same time
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

What do you need most right now? *

a sense that I’m not alone in my grief
contact with people with a similar migration experience
understanding for my longing for my country/family
a place where I don’t have to explain my story
doing something together with others
a space where I can be myself
a moment to breathe and step away from everyday life
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

Do you have people in Poland you can rely on? *

yes, I have close ones/friends in Poland
I have a few people, but I don’t feel strongly supported
I’m on my own, without support from family or friends
I prefer not to answer

Do you currently have any support in coping with your emotions? *

yes, I’m in contact with a specialist (psychologist, psychiatrist)
yes, I have support from another source
no, I don’t have this kind of support
I prefer not to answer

We ask about psychological support because the circle is community support, not therapy. If you are in therapy or under psychiatric care — that’s great. The circle can be an additional layer of support

How often in the last 2 weeks have you had thoughts that life has no meaning? *

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 answering so honestly. Your responses 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.

For people with migration experience (support available in Ukrainian, Russian, Polish, and English):

Polskie Forum Migracyjne – support helpline: +48 22 255 22 02 (7 days a week, 12:00–22:00; hours may change).
Fundacja dla Migrantów “Dobry Start” – free support: +48 736 380 203; email: biuro@fds.org.pl.
Ukrainian House in Warsaw – helpline: +48 727 805 764 (hours may change).

For people in a severe mental health crisis (nationwide numbers in Poland):

Support Centre: 800 70 2222 (free, 24/7).
Helpline for children and young people: 116 111 (free, 24/7).
Bereavement support – Fundacja Nagle Sami: 800 108 108 (Mon–Fri, 14:00–20:00).
Online consultations in crisis: zwjr.pl (Życie Warte Jest Rozmowy Foundation).

f your life or health is in immediate danger — call 112.

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.

ciągu sytuacji obecny

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

I need step-free access (no stairs)
A seat with a backrest is important to me
I don’t have any specific needs in this area
Other (you can add details at the end of the form)

Miejsce, w którym odbywa się spotkanie, jest częściowo pozbawione barier architektonicznych

Do you need any specific communication support?

interpretation into Polish Sign Language (PJM)
amplified sound (hearing loop)
I don’t have any specific needs in this area

You can select more than one option

Care responsibilities

I need to know whether I can bring a child to a specific meeting
I need to know whether I can bring my pet to a specific meeting

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 community support, not therapy
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/