Teen Backpack Application (Parent/Guardian)

Teen Backpack Application (Parent/Guardian)

Thank you for your interest in having your teen join us for one of our Teen Backpacking Trips. We are available to help with this application. If you need help or have any questions, call/text us at 360-358-3213 or email info@wildgrief.org.
Before completing this application, you must review the Eligibility Criteria. If you have questions about their eligibility, please contact us via phone or email prior to filling out the application. If you do not think they meet the requirements, please reach out to us about other Wild Grief program options or referrals to other grief support.
Have you reviewed the eligibility criteria and believe your teen meets all requirements?*

Yes, I reviewed and understand the eligibility criteria and believe my teen meets all requirements.
Teen's Name*

First NameLast Name
Teen's Preferred Name
Teen's Pronouns
Teen's Gender*
Teen's Birth Date*

MonthDayYear
Date
Teen's Email*
(We will cc you any emails)
Teen's Phone Number

Area CodePhone Number
Parent/Guardian 1 Name (primary contact)*

First NameLast Name
Preferred Name (if different than above)
Relationship to Teen*
Mother, Aunt, Grandfather, etc.
Parent/Guardian 1 Mobile Phone*
Parent/Guardian 1 Best Other Phone
Parent/Guardian 1 Email*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Second Parent/Guardian's Name (optional)

First NameLast Name
Preferred Name (if different than above)
Relationship to Teen
Mother, Aunt, Grandfather, etc.
Parent/Guardian 2 Mobile Phone
Parent/Guardian 2 Email
For which hike dates is your teen available?*

Trip 1: Thursday, July 25- Sunday, July 28, 2024Trip 2: Thursday, August 1- Sunday, August 4, 2024Trip 3: Thursday, August 15- Sunday, August 18, 2024Any of the above work for us
Which is your preferred trip(s)?
It will really help the hiker's and your experience to be at the mandatory orientation picnic on Saturday, July 20th in Olympia. Are you able to attend?

We can attend the Orientation Picnic on Saturday, July 20thWe can't make it on this date
How did you or your teen first hear about us?*

CounselorWeb SearchFacebookInstagramOther Grief GroupPast ParticipantFriendFamilyReligious/Spiritual CommunitySchoolOther
Has your teen attended any other Wild grief programs? (We welcome previous backpackers on a space-available basis.)

Teen BackpackTeen or Family Day HikeFamily Journey Camp OutHike HabitMy teen has not attended any other Wild Grief ProgramsOther
Below are questions about the death and how your teen is doing. These questions will help us understand how we can provide the best experience for your teen. There are no right or wrong answers. Please be as honest as you can. This information is confidential and will not be shared outside of Wild Grief. We will be sharing it with the guides on your trip.
Who died and what was their relationship to the teen?*
What were the circumstances of the death? How did the person die?*
When did the death occur? (Month/year)*
What should we know about your teen and their grieving?*
What, if any, behaviors are you concerned about?*
What, if any, other grief support has your teen participated in and when? (Example: Counselor, Peer Grief Support Group, other camps (Camp Erin, Camp Rosey), etc)*
What do you hope your teen will get from this trip?*
Who first brought up this trip?*

YouYour Teen
What is your sense of how your teen is feeling about this trip?*
What, if any, concerns do you have about this trip?*
Describe you teen's experience with camping, backpacking, or hiking (no experience necessary)?*
Is there anything else you would like to share about you or your teen?*
Wild Grief’s programs are funded by grants. You can help keep our programs available and free of charge by answering the questions below to help our funders understand who we are serving. We will share only the combined results with our funders, without identifying you. This information will also help us improve our programs. All questions are optional, and you may decline to answer.
What County do you live in?*
Please select the race/ethnicity of the teen (select all that apply)*

American Indian or Alaska NativeAsianBlack or African AmericanMiddle Eastern or North AfricanNative Hawaiian or other Pacific IslanderHispanic or LatinoWhiteDecline to answerOther
What is the primary language spoken at home?
Gender*

WomanManTransgender WomanTransgender ManNon-binaryAgenderDecline to answerOther
Household Income*

< $30,000$30,000-$50,000$50,000-$80,000> $80,000Decline to answer
Does your teen qualify for free/reduced lunch at school?*

YesNoI'm not sureDecline to answerOther
Newsletter

I would like to receive Wild Grief's email newsletter.
Thank you for applying for your teen to join us on the trail. You must also submit the Medical/Emergency Form and have your teen submit the Teen Application to complete the application process. Once all forms are submitted, we will review them and contact you about the next steps in the application process.

By signing below you are agreeing to the following: All the answers I have provided in this application are true. I am the parent/guardian of the named teen with permission to allow their participation in this program.
Signature*
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