Child Application

Child Attendee Application

-MUST BE A RESIDENT OF SOUTH CAROLINA
- Children from 5 to 18 years of years of age (at least ONE adult must attend with a youth camper)
- Lost loved one did not have to be hospice patient for family to attend
- The loss of your loved one must have happened within the past three years
- You will be responsible for travel to and from event location
- There is a $50 registration fee per family (Only to be paid once approved for camp)
- If you family should need your registration fee waived, please complete a Registration fee waiver, you will have the option to complete it, after being approved for camp.

* 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 *

Gender *

Child's T-Shirt Size *

Ethnicity *

Grade in School *

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) *

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 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.*