Family Camp 2025 Application & Registration Forms

Family Camp 2025 Application & Registration Forms

We are excited to invite you to join us for a special Family Camp experience with Myra’s Kids Foundation! This camp is designed to provide families with a nurturing environment to connect, heal, and create lasting memories together as they navigate their grief.
Family Camp: Saturday, June 14, 2025 - 9:00AM - 5:00PM

at Royal Vale School - 5851 Somerled Ave, Montreal, Quebec H3X 2A5 - (registration opens at 8:30AM)

Important Information - Family Camp 2025

Family Camp: Saturday, June 14, 2025
I understand that a complete application is necessary for consideration. Once submitted, a Myra’s Kids Foundation team member will contact me to arrange a mandatory intake interview, which I must attend to participate.*

Agree
I recognize that Family Camp is offered at no charge, made possible by our supportive community and donors. If my circumstances change after acceptance, I agree to promptly notify Myra’s Kids Foundation to allow another family to benefit.*

Agree
I understand that securing transportation to and from Family Camp is solely the responsibility of my family, and MKF will not be responsible for providing any transport.*
Should you need help with transportation, kindly notify an MKF representative, and we will make every effort to assist you.

Family Information
Family Last Name*
Primary Contact First Name*
First Name
Primary Contact Maiden Name
(if applicable)
Primary Contact Email*
example@example.com
Primary Contact Phone Number*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityProvince

Postal CodeCountry
Please upload a recent family photo (or individual photos of your family members) that includes all members attending Family Camp. This will help us recognize and welcome you to the camp.*

Cancelof

Family Members Attending
Number of Adults Participating (18+)*
Number of Children Participating*
Family Details

Please provide details for each family member attending:
Participant 1 - Name (if you are the Primary Contact, please fill it out for yourself)*

First NameLast Name
Participant 1 - Age (if you are the Primary Contact, please fill it out for yourself*
Participant 1 - Birthday (if you are the Primary Contact, please fill it out for yourself*

MonthDayYear
Date
Participant 1 - Relationship to Primary Contact
If you are the primary contact, please leave this blank.
What is your T-shirt size? Kindly choose from the dropdown menu*
Participant 2 - Name*

First NameLast Name
Participant 2 - Age*
Participant 2 - Birthday*

MonthDayYear
Date
Participant 2 - Relationship to Primary Contact*
What is your T-shirt size? Kindly choose from the dropdown menu*
Participant 3 - Name

First NameLast Name
Participant 3 - Age
Participant 3 - Birthday

MonthDayYear
Date
Participant 3 - Relationship to Primary Contact
What is your T-shirt size? Kindly choose from the dropdown menu*
Participant 4 - Name

First NameLast Name
Participant 4 - Age
Participant 4 - Birthday

MonthDayYear
Date
Participant 4 - Relationship to Primary Contact
What is your T-shirt size? Kindly choose from the dropdown menu
Participant 5 - Name

First NameLast Name
Participant 5 - Age
Participant 5 - Birthday

MonthDayYear
Date
Participant 5 - Relationship to Primary Contact
What is your T-shirt size? Kindly choose from the dropdown menu
Should you be attending with more than 5 individuals, please use this space to detail additional information about your family members.

Family Activities and Interests
Which of the following camp activities do you think your family would enjoy? (Please check all that apply)*

Outdoor gamesCreative arts and craftsTeam-building exercisesMindfulness and relaxation activitiesFamily discussions/groupsOther
Are there any hobbies or activities your family particularly enjoys?
Do you foresee any challenges or concerns regarding your family's participation in Family Camp?*
(This helps us address potential issues proactively.)

Emergency Contact

In case of an emergency during camp, please provide the name, phone number, and relationship of an emergency contact who is not attending Family Camp.
Emergency Contact Name*

First NameLast Name
Emergency Contact Phone Number*
Please enter a valid phone number.
Relationship to Primary Contact*
In the event of an emergency, I acknowledge that Myra’s Kids Foundation will make every reasonable effort to contact the emergency contact provided. I further authorize Myra’s Kids Foundation to make necessary decisions regarding my family's care and safety if immediate action is required or if the emergency contact cannot be reached. I hereby release and hold harmless Myra’s Kids Foundation, its staff, and volunteers from any liability arising from such actions.*

Agree

Mental Health and Emotional Needs
Are any family members currently receiving psychological or social work support?*
If yes, please provide details (e.g., type of support, frequency, and provider contact information):
Please indicate any social/social emotional challenges your family is currently experiencing by selecting any options below that may apply.*

No specific emotional needs or challengesCoping with grief or lossExperiencing anxiety or depressionBehavioral or mood-related concernsDifficulty managing stressSocial isolation or adjustment challengesTarget of bullying behaviourOther

Additional Information
Is there anything else you think we should know before completing this application for Family Camp?

Photo, Publicity, and Liability Waiver
By participating in MKF Family Camp 2025, you acknowledge and agree that photos or videos may be taken during camp activities for use in promotional materials. Should you have concerns, please indicate them during the intake process.*
I acknowledge that if any significant changes or losses occur within my family after submitting this application, I will promptly notify Myra’s Kids Foundation*
By submitting this form, I confirm that the information provided is accurate, and I understand the program is conducted in English.*
By submitting this application, I affirm that all the information provided is true and complete.*

Confirm
Primary Contact Name*

First NameLast Name
Signature*

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Family Camp 2025 Application & Registration Forms

Family Camp: Saturday, June 14, 2025 - 9:00AM - 5:00PM

Important Information - Family Camp 2025

Family Information

Family Members Attending

Family Details

Connection to Myra’s Kids Foundation Programs

Grief and Bereavement Context

Family Activities and Interests

Medical and Dietary Information

Emergency Contact

Mental Health and Emotional Needs

Inclusivity and Demographic Information

Additional Information

Photo, Publicity, and Liability Waiver