Camp Erin Los Angeles 2026 Camper Application

We are currently accepting applications for Saturday, August 22nd and Sunday, August 23rd.

Important Notes:

*A phone call and pre-camp appointment conducted by our clinical staff will be required after the completion of this application.

*We ask that all campers be told by their caregiver about Camp Erin LA prior to their interview.

*A separate application must be completed for each Camper.

Applying for more than one child? Once you submit your application, select “Submit an Additional Camper Application” on the Thank You page to start the next form. Your Parent/Guardian information will automatically carry over for the next camper.

Camper Information

Parent/Guardian Information

The camp schedule includes an adult program that requires the participation of one parent or guardian per family. We will provide adult programming separate from your camper’s experience throughout the camp day. Adults will participate in a range of activities, connect with other camper guardians, and attend the closing luminary ceremony of their campers. One guardian is required to attend camp.

Please provide information for the accompanying guardian below.

Bereavement & Family History

We understand that these questions may be difficult to answer. This information helps us better support your Camper in their grief and provide the best possible care.

Please tell us about the significant person the Camper is grieving.

Please note: It is in your Camper's best interest to know the true cause of death. Therefore, it is a requirement of Camp Erin LA that Campers know the true cause of death, if it is known to the family. Camp Clinical Staff are available to assist you in having this conversation with your Camper and to provide clinical rationale for this requirement.

Camper's Reaction to the Death

Please mark all of the following behaviors, thoughts, and feelings the Camper has exhibited since the death of their significant person.

Household & Prospective Camper Health Information

Please note: This application must be completed by the Camper's parent or legal guardian, and a separate application must be submitted for each camper.

Household Information

Prospective Camper Health Information
Please select all that apply.

Emergency Contacts

Please list two local people other than the accompanying adult that OUR HOUSE can contact in case of an emergency.

Demographics

The questions in the following section are optional and are not used to determine acceptance. This information helps us better meet the needs of our community and secure critical funding.

If you have any questions regarding Camp Erin LA, please contact Juliana Sanabria, Clinical Coordinator of Camp, at (310)-231-3186 or juliana@ourhouse-grief.org.

Consent to Release Information

(OUR HOUSE Grief Support Center Staff to Provider & Provider to OUR HOUSE Grief Support Center Staff)

Signing this document authorizes OUR HOUSE Grief Support Center to communicate with your mental health (therapist or psychiatrist) or healthcare (medical doctor) provider regarding grief support groups and your interaction with OUR HOUSE staff. Should your safety or the safety of another be of concern, this consent allows us to collaborate with your healthcare team to provide the best care possible. Failure to provide all requested information will impede our ability to collaborate with those who know you best. 

I consent for OUR HOUSE Grief Support Center to exchange information regarding my Camper with my their therapist/healthcare provider. This consent allows OUR HOUSE Grief Support Center to release information regarding my Camper's participation in group, as well as interactions with agency personnel including, but not limited to, my Camper's attendance to group sessions, behaviors and verbalizations regarding safety concerns and emotional states.

I consent for my Camper's therapist/healthcare provider to exchange information with OUR HOUSE Grief Support Center. This consent allows my Camper's therapist/healthcare provider to provide the following information: adherence to treatment including attending appointments, taking medications as prescribed, clinical risk assessments (including, but not limited to, suicidality, homicidality, and/or grave disability), participation in treatment planning, psychiatric hospitalizations, and any other pertinent information that may impact group/camp participation.

This consent expires one year from the date of authorization indicated by the signature at the bottom of this page.

Applying for more than one child?  After clicking "Submit" at the bottom right of this page, choose "Submit an Additional Camper Application" on the next screen. Your Parent/Guardian information will automatically carry over for the next Camper.