2026 Camp Erin LA Application Form - English

  • Camp Erin Los Angeles 2026 Camper Application

    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.

  • This summer we are hosting two options for our day camp. Please mark the session you and your Camper(s) would PREFER to attend:*
  • Please mark the session(s) that you and your Camper(s) are AVAILABLE to attend. We will do our best to accommodate*

  • Camper Information

  • Camper's Gender*
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  • Camper's Primary Language*
  • Has your Camper participated in an OUR HOUSE Group?*
  • Has your Camper attended Camp Erin LA before?*
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  • Has your Camper received any disciplinary action for behavior from school and/or a previous camp?*
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  • Tag_Adult
  • Tag_Child

  • 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.

  • Format: 000.000.0000..
  • Accompanying Parent/Guardian's Gender*
  • Accompanying Parent/Guardian's Relationship to Child: "I am the camper's ______."*
  • Is the accompanying adult the camper's legal guardian?*
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  • Accompanying Parent/Guardian's Preferred Language*
  • Is there another adult in your camper’s life who would also like to attend camp?
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  • Additional Adult's Relationship to Child: "They are the camper's _____."

  • 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.

  •  / /
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  • Cause of Death*
  • Parent/Guardian Relationship to the Deceased: "I am grieving my _______."*
  • Their Relationship to the Camper: "They were the Camper's ______."*
  • Was the person who died a significant caregiver to the Camper? A significant caregiver is a family or non-family member who provided significant support (housing, financial, care, etc.) to the Camper.*
  • Was your Camper present at the time of death?*
  • Has your Camper been told the facts about the cause of death?*

  • 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.

  • Is the Camper displaying any behaviors and/or moods that concern you?
  • Is this the Camper's first experience with death?*

  • 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.

  • Physical Changes*
  • Thoughts & Feelings*
  • Behaviors*
  • Has the Camper ever witnessed or experienced violence of any kind?*
  • Has the Camper ever been removed from their home due to abuse or neglect of any kind?*
  • Is there currently an open case with the Department of Child and Family Services?
  • Is the Camper currently connected to mental health support/services?*
  • Please mark all that apply:

  • 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.

  • Has your camper...*
  • Is your Camper currently taking any medications?*
  • 1. Will this medication be administered at camp?
  • 2. Will this medication be administered at camp?
  • 3. Will this medication be administered at camp?
  • 4. Will this medication be administered at camp?
  • Does your Camper take additional medications that you were unable to list here?
  • Does the Camper have any history of operations or serious illnesses?*
  • Does the camper have any special needs, physical limitations, or diagnosed conditions we should be aware of? This includes any developmental or learning disabilities, mental health diagnoses, or services such as an IEP or occupational therapy.*
  • Does the camper have any dietary restrictions or unique eating habits we should be aware of? This includes any physician recommended, religious, or medically related dietary needs.*
  • Does the Camper have any allergies? This includes food, medication, environmental, insect sting, or seasonal allergies.*

  • Emergency Contacts

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

  • Format: 000.000.0000..
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  • How did you hear about Camp Erin LA?*
  • Would you like to receive communication about OUR HOUSE Grief Support Center programs and events?*
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  • 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.

  • Household Income
  • Household Income
  • Household Income
  • Household Income
  • Household Income
  • Household Income
  • Household Income
  • In the past year, have you or anyone in your household qualified for any government assistance programs? This includes free or reduced-price school meals, WIC, SNAP, housing assistance, Medicaid, or SSI.*
  • Camper's Ethnicity*
  • Camper's Race*
  • Parent/Guardian's Ethnicity*
  • Parent/Guardian's Race*
  • Does the camper’s parent or guardian, or the person who died, have any current or past military affiliation (active duty, reserve, or veteran)?*
  • Which branch of the military were they affiliated with?

  • 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.

  • I consent for OUR HOUSE Grief Support Center to exchange information regarding my Camper with their therapist/healthcare provider, and for my Camper's therapist/healthcare provider to exchange information with OUR HOUSE Grief Support Center.*
  • Format: 000.000.0000..
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  • 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.

     

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