Camp Erin-Twin Cities DAY CAMP Camper Application

Camp Erin-Twin Cities DAY CAMP Camper Application

June 18th, 2022
*Please fill out one application for every camper
Name *

First Name Last Name
Name to be printed on name tag (if different)
Gender Pronoun

She/Her/Hers He/Him/His They/Them/Theirs
Date of birth (Campers ages 6-17) *

Month Day Year
Date
Age *
Grade in Fall (2022) *
Address
City
State
Zip
Please list brothers/sisters attending camp
Camper's Ethnicity/Race (The following question is required by our partner, Eluna, and used for grant funding purposes only. All information collected is confidential.) *

African American/Black Asian Hispanic/Latinx Multi-Race Native American Pacific Islander White Other
Does the camper qualify for reduced or free school lunch? (The following question is required by our partner, Eluna, and used for grant funding purposes only. All information collected is confidential.) *

Yes No
How did you learn about Camp Erin?
Parent/Guardian *

First Name Last Name
Cell Phone *
E mail Address *
example@example.com
Emergency Contact if parent/guardian can't be reached *

First Name Last Name
Relationship to camper *
Phone *
INFORMATION ABOUT THE PERSON WHO DIED:
Name of loved one who died *
Relationship of loved one to the camper *
When did the death occur (date)? *

Month Day Year
Date
Age of person who died *
Was their special person an Active, Reserve, or National Guard Military member or Military Veteran? (The following question is required by our partner, Eluna, and used for grant funding purposes only. All information collected is confidential.) *

Yes No
If so, what branch?
Cause of Death:
(Please explain any important details surrounding the death that could be helpful.)
Did the camper live with the person who died?

Yes No
Is the camper fully aware of the circumstances surrounding the death?

Yes No
If not, please explain:
Is this your camper's first experience with death?

Yes No
If not, what other death related losses has your child experienced?
TELL US ABOUT YOUR CAMPER:
Are there any specific concerns or information regarding your camper's behavior that would be helpful to know prior to camp?
Are there any changes your child is currently coping with?
(i.e. new schools, moving, re-marriage, struggling with school, friendship changes, etc.)
MEDICAL INFORMATION:
Does your camper have any food allergies or restriction? If so, please explain:
Are there any other medical or mental health diagnosis or conditions your child has experienced that we should be aware of? If yes, please explain:
Will your child need to take medications while at camp?

Yes No
If yes, please indicate prescription name, dosage, time of day:
We strive to ensure that every child and family has an opportunity to participate in our programming. While we understand that schedules can change, we ask that you consider your submission a commitment as our limited capacity may require us to turn others away. We thank you for your consideration of others.
If you have further questions please contact Adrian Olsen, Brighter Days Center Coordinator at 952-303-3873 or Adrian@brighterdaysgriefcenter.org.
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Camp Erin-Twin Cities DAY CAMP Camper Application

If you have further questions please contact Adrian Olsen, Brighter Days Center Coordinator at 952-303-3873 or Adrian@brighterdaysgriefcenter.org.