Portraits of Hope

Portraits of Hope is voluntary program for our grief program participants and is free of charge. To participate in the program please complete the form below.

The program is run by William Small. To learn more about Bill’s work, click here to visit Bill’s website. Be sure to return to this page and fill out the form to participate.

Date*
MM slash DD slash YYYY
Name*
First Last
Address*
Street Address City State ZIP Code
Cell Phone
Home Phone
Email*
Enter Email Confirm Email
Name of Deceased:*
First Last
Date(s) eg. year of death or dates of birth/death:*
MM slash DD slash YYYY
Special note:
Upon completion of portrait, we will notify you by email and make an appointment for pick up.
The Contra Costa Crisis Center or William Small may display a copy of my completed portrait:*
- On the Portraits of Hope wall at the Crisis Center (rotating)
- On the Crisis Center website as an example of the project
- I wish to decline any display, digital or print, of my finished portrait
Consent*
I consent to participate in the Portraits of Hope - see below:
I understand that I am agreeing to participate in the Portraits of Hope program voluntarily. I understand that the photograph I provide the Crisis Center will be stored and shared electronically with William Small, artist for the Portraits of Hope project. I understand that the Contra Costa Crisis Center and William Small will not reproduce or share the photograph or portrait without my expressed written consent (above) and that I may withdraw my consent at any time in the future by notifying the Contra Costa Crisis Center and William Small in writing. I understand that should I need grief counseling support at any time during the Portraits of Hope project, I can access a counselor 24 hours a day by dialing 988.
Photo Upload
Drop files here or

Max. file size: 50 MB, Max. files: 3.
You can upload up to 3 photos for Bill to work from. Or you can wait until we contact you if you prefer.

If you have questions or need further information, please contact our Programs Director, Lesley, at LesleyG@crisis-center.org. Download the Portraits of Hope flyer here.

Portraits of Hope

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