Safe Harbour Order Form

There was an error on your page. Please correct any required fields and submit again. Go to the first error

You can complete this form to request a free copy (or copies) of Safe Harbour – an illustrated storybook for children who have been bereaved by suicide – from the HSE National Office for Suicide Prevention (NOSP).

Information about Safe Harbour, and .pdf versions of the books, are available to download at www.childhoodbereavement.ie/safeharbour.
Worksheets for activities that accompany Safe Harbour, are available to download or print at www.childhoodbereavement.ie/safeharbour/calming-exercises.
For advice on coping with grief after bereavement or loss, and how to support others, visit www.hse.ie/grief.
Please note that we are only able to fulfil orders in the Republic of Ireland at present.

Your information

The information you provide on this form will be used in the following ways.

Your name, address, Eircode and telephone number will be provided to our delivery company, for delivery purposes only.
Your address and telephone number will not be retained by us thereafter.
Your other information including email address, will be retained for 24 months.
With your consent, we would like to contact you again in the future, to hear your feedback. This would be by email. Your feedback about Safe Harbour, how you used it and your suggestions for improvement, will help us enhance these resources for other families. You can withdraw consent at any time.

*

Do you agree to be contacted by email, for the above purpose in the future?

Yes

NO

*

Your details

This question requires an answer

First Name

Surname

Organisation

Job title

Email address

Address 1

Address 2

Address 3

Address 4

County

Eircode

Telephone number

Please note:

We cannot process orders with our delivery company, without a full address, Eircode, and telephone number.
We are only able to fulfil orders in the Republic of Ireland at present.

*

Your background

I would like to use Safe Harbour within my personal circles, for example, family and friends

I would like to use Safe Harbour in my professional work

Other (please specify):

This is required

How many copies of Book A would you like to request? (max 5)
In this version of the storybook the child’s father dies, and is supported by their mother.

How many copies of Book B would you like to request? (max 5)
In this version of the storybook, the child’s mother dies and is supported by their father.

How many copies of the book as Gaeilge would you like request? (max 3)
In this version of the storybook in Irish, the child’s father dies, and is supported by their mother.

Please 'Submit' to complete your order.

Note, all copies of Safe Harbour come with Safe Harbour, a Helpful Guide for Parents and Carers, and additional materials.

If you have requested multiple copies of Safe Harbour, a smaller quantity of books may be delivered to you, dependent on availability.

Further enquiries, email: safeharbour@nosp.ie.