Camp Journey FAMILY DAY CAMP Application

Thank you for your interest in Camp Journey Family Camp on September 14th, 2024, at Camp Confidence Learning Center in Brainerd Minnesota from 9am-5pm. Camp Journey (Camp Erin - Brainerd) is a program of Brighter Days Family Grief Center, part of the Eluna Network.

Family Camp is a one day camp for all family members ages 5 and up. At least one family member must be in the age range of 5-17 and there must be at least one parent/guardian attending. We will provide child care for children ages 4 and under when parents/guardians are in groups. For all other activities, parents/guardians will be responsible for child care to ensure the whole family can participate in the camp experience together.

We encourage families to participate who have had some experience in a grief group setting or individual grief counseling, and have had at least 6 months pass from the date of their loved ones death.

Please note this application does not guarantee approval. Once your application is submitted, we will schedule a phone call with you to answer any questions and to determine camp readiness for all family members.

Due to the number of families who want to participate, we ask that all family members are able to commit to the full day (9am-5pm) before submitting your appplication.

How did you learn about Camp Journey?*

Parent/Guardian who will be attending*

First NameLast Name

Preferred Pronouns

T-shirt Size*

Other Parent/Guardian who will be attending

First NameLast Name

Preferred Pronouns

T-shirt Size

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone number *

E-mail address to send camp communications to:*

example@example.com

Will you need childcare for children under 5 years old? If so, please list names and ages.

Child's Name*

First NameLast Name

Date of birth (Campers ages 5-17)*

Date

Preferred Pronouns

T-shirt Size (youth sizes are S, M, L-if your child wears an adult size, please note that here). *

Child's Name

First NameLast Name

Date of birth (Campers ages 5-17)

Date

Preferred Pronouns

T-shirt Size (youth sizes are S, M, L-if your child wears an adult size, please note that here).

Child's Name

First NameLast Name

Date of birth (Campers ages 5-17)

Date

Preferred Pronouns

T-shirt Size (youth sizes are S, M, L-if your child wears an adult size, please note that here).

Child's Name

First NameLast Name

Date of birth (Campers ages 5-17)

Date

Preferred Pronouns

T-shirt Size (youth sizes are S, M, L-if your child wears an adult size, please note that here).

The following 3 questions are required by our partner, Eluna, and used for grant funding purposes only. All information collected is confidential.

Ethnicity/Race (check all that apply for the family members participating)*

Do any family members qualify for reduced or free school lunch?*

YesNo

Was the person who died an Active, Reserve, or National Guard Military member or Military Veteran?*

YesNo

If so, what branch?

INFORMATION ABOUT THE PERSON WHO DIED:

Name of loved one who died?*

Relationship of loved one to the family*

When did the death occur (date)?*

Date

Age of person who died?*

Cause of Death: *

(Please explain any important details surrounding the death that could be helpful.)

Are all family members fully aware of the circumstances surrounding the death?*

YesNo

If not, please explain:

Are there any other death related losses that your family has experienced?*

Have any of your family members participated in grief counseling or grief support groups since your loss? *

TELL US ABOUT YOUR FAMILY:

Are there any specific concerns or information regarding your family's grief experience that would be helpful to know prior to camp?*

Are there any changes your family is currently coping with such as illness, move, divorce, or marriage? *

(i.e. new schools, moving, re-marriage, struggling with school, friendship changes, etc.)

MEDICAL INFORMATION:

Do any family members have any food allergies, dietary restrictions, or require medication to be taken at camp? If so, please explain which family member, what allergy/restriction, and name of medication.*

Are there any other medical, behavioral or mental health diagnosis or conditions any family member has experienced that we should be aware of, including in-patient or intensive outpatient care? If yes, please explain which adult/child, condition/diagnosis, and dates of in/outpatient care.*

Has any family member indicated signs of harm to self or to others? If yes, please explain the circumstances and timeline that this occurred.*

We strive to ensure that every family has an opportunity to participate in our programming. While we understand that schedules can change, we ask that you ensure each family member can attend the full day of camp before submitting your application. Thank you.

Camp Journey Family Day Camp

The application window is July 8th to August 1st or until the camp fills.

For questions, contact Carolyn Kinzel, Executive Director, carolyn@brighterdaysgriefcenter.org or 952-219-8512.