Camp Kinard Child Application

Child Attendee Application

MUST BE A RESIDENT OF SOUTH CAROLINA
Children from 5 to 18 years of years of age, no exceptions (at least ONE adult must attend with a youth camper)
Lost loved one did not have to be a hospice patient for family to attend
The loss of your loved one must have happened within three months - three years from the date of camp
All applicants will be pre-screened before approval to determine if camp is appropriate for your family
You will be responsible for travel to and from event location
There is a $50.00 registration fee per family (ONLY to be paid once approved for camp)
If your family should need the registration fee waived, please complete a Registration Fee Waiver, you will have the option to complete it, after being approved for camp
This application is best filled out on a laptop or desktop and NOT a phone, thank you for your understanding

* Indicates required field

Name of Child Applicant *

First

Last

Date of Birth (MM/DD/YYYY) *

Contact Information

Name of parent/guardian attending with child (at least ONE adult must attend camp with child) *

First

Last

Relationship to child attending *

Name of additional parent/guardian attending with child (if applicable) *

First

Last

Relationship to child attending *

Address *

Line 1

Line 2

City

State

Zip Code

Country

County *

Parent/Guardian Phone Number *

Emergency Contact Name *

First

Last

Emergency Contact Phone Number *

Email *

General Information

Child's Age (at time of camp) - MUST BE 5 OR OLDER, NO EXCEPTIONS *

Gender *

Child's T-Shirt Size *

Ethnicity *

Grade in School (Must be K-12, no exceptions) *

Name of School Child Attends *

Child's Special Talents, Skills, or Unique Interests *

How did you hear about Camp Hands of Hope? *

Medical Information

Is your child up-to-date on all vaccinations? *

Does child have any medical, physical, or mental health issues or limitations? (if yes, please explain; if no, please type "n/a") *

Does child have any Dietary Restrictions, Allergies (food or non food) or hypersensitivies? (if yes, please explain; if no, please type "n/a") *

Please list any medications that will be taken at camp? (specify name, dose, and frequency; if none, please type "n/a") *

Bereavement Information

Has your child/family attended Camp Hands of Hope before? *

Name of loved one who passed away *

First

Last

Date of Death (MM/DD/YYYY) *MUST BE BETWEEN 3 MONTHS - 3 YEARS FROM THE DATE OF CAMP *

If your child/family has attended camp before, please explain how the child has been doing since their last camp experience. (if no please type n/a) *

Has your child/family attended other bereavement camps? (if yes, please specify; if now, please type "n/a") *

If child was present at time of death, please explain circumstances (if not please type n/a) *

Relationship of deceased to child *

Please explain how your child has been grieving since the loss. *

Cause of death *

Have there been multiple losses of loved ones experienced by this child? *

Age of the deceased at time of death *

Has your child received any professional support to help with their grief? *

Have there been any other changes or stresses in your child’s life? (i.e., divorce, remarriage, relocation, illness, etc) if none please type n/a *

Other questions, comments, or concerns that you may have *

If yes, please tell us when the loss occurred and the child’s relationship to the additional person(s) that were lost. (if none please type n/a) *

Please list or explain any additional information you would like to share about your child and the way they handled the recent loss of their family member or friend. *

I hereby certify that all the information above is accurate to the best of my knowledge. *

Please type your name below to certify this information. *

Note: please make sure that each person - child or family member - attending camp has submitted an individual application. For example, if a mother is bringing two of her children, three applications must me submitted - one "Adult Application" for the mother and two "Child Applications" for her children.

Applications are accepted until spaces are filled.
Applications are evaluated on a first come first serve basis.
Families that have attended camp two or more times previously will be wait listed and require an interview.
Families that have attended camp two or more times previously are not eligible for an application fee waiver.
Submitting an application does not guarantee you a spot for camp. We will send an email notifying you of your status once applications have been reviewed.

If accepted into camp, you will need to pay the $50.00 family registration fee or complete a registration waiver fee.

The Hospice & Palliative Care Foundation does not discriminate on any basis of who is accepted into camp.

Submit Application

*Please make sure you have completed ALL areas of this application. If you DO NOT see a "Completed Application" notification on the page once you click "Submit Application,” please review the application and look for any red boxes and stars, indicating a required field you may have failed to complete.*