Formularz zapisowy: Grief Soup - Dom Ukojenia | Grief House Warsaw

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1About you

2Food preferences 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? *

28 March 2026
11 April 2026

Please sign up for one selected date only

Which language do you feel most comfortable speaking? *

in Polish
українською мовою
in English

Select the language in which you are most comfortable communicating

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
death of a loved one by suicide
multiple loss (the death of several close people within a short period of time)
perinatal loss
loss of a companion animal
significant loss of health (your own or a loved one’s)
loss of job / important life role
loss of place (e.g. migration, forced relocation, refugee experience)
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)? *

1 to 5 months ago
6 months to 1 year ago
1–2 years ago
more than 2 years ago
I am expecting a loss (a loved one is seriously ill/dying)

Indicate approximately how much time has passed since the loss

What do you need most right now? *

a sense that I’m not alone in my grief
doing something together with others
a space where I can be myself (talk or stay silent)
a moment to breathe and step away from everyday life
warmth and a homely atmosphere
being among people who understand me
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

The use of specialist support does not affect your ability to attend Serenity House meetings. This point tells us if you have other resources besides our meetings that you can use.

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

alergeny najwygodniej potrzebujesz?

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)

Kitchen preferences and comfort

Let us know about your needs — this will help the facilitators prepare for the meeting in a thoughtful way.

Do you have any dietary restrictions or food preferences? *

I don’t eat meat (vegetarian)
I don’t eat animal products (vegan)
I don’t eat pork (religious reasons)
I have a food allergy or intolerance
I follow another diet (you can specify at the end of the questionnaire)
I have no dietary restrictions

We want everyone to feel safe and comfortable eating the shared meal. Please let us know about your needs

If you have a food allergy, please list the allergens:

If you use an EpiPen, please bring it with you. Our facilitators are trained in first aid.

How do you feel about cooking together?

I enjoy cooking and would be happy to help
I don’t have much experience, but I’d like to try
I prefer to observe or help with simple tasks
I’d rather focus on conversation than cooking
I’m not sure yet — I’ll see how I feel on the day
I may not be a great cook, but I’m a very willing eater 🙂

This helps facilitators assign tasks in a way that respects everyone’s comfort.

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?

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 (add details at the end of the questionnaire)

The meeting space is barrier-free, has an accessible toilet, and includes a quiet room where you can rest if needed.

Do you need any specific communication support?

interpretation into Ukrainian
interpretation into English
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.

Grief Soup

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/