Camp Conquer Application

Camp Conquer Application

Camp Conquer for ages 8-12 is June 1-5. Camp Conquer for ages 13-17 is June 16-19th. Applications close on April 10th. Please note: Submitting an application to the Kids Grief Camp does not guarantee admission. All applications will be reviewed, and acceptance is based on available space and program criteria. Applicants will be notified of their acceptance status by May 1st.”
Child's First and Last Name*

First NameLast Name
Child's Birthday*

MonthDayYear
Guardian's First and Last Name*

First NameLast Name
Guardian's Phone Number*
Please enter a valid phone number.
Emergency Contact's First and Last Name*

First NameLast Name
Emergency Contact's Phone Number
Please enter a valid phone number.
Who did the child lose?*
When did the loss occur?*
What was the nature of the loss?
Has the child attended any grief support programs? Please select all that apply*

Camp ConquerClub ConquerFamily DaysNo
How does your child typically express grief or emotions? *
Are there any recent changes in mood or behavior?*
What helps your child feel comforted or safe when upset?*
Is your child currently under the care of a counselor?
Does your child have an allergies, medical conditions, or medications?*
Does your child have any dietary restrictions?*
Does your child have any sensory, physical, or emotional needs we may need to be aware of?*
What do you hope your child will gain from attending Camp Conquer?*
Is there anything specific you'd like our team to know to best support your child?
I, First Name Last Name grant The Retreat at Quarters Lake consent to photograph/video my child during camp and use these photos for social media marketing purposes.
Guardian Signature

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