• Camp Braveheart Family Workshop Registration

  • Parent/Guardian Information

  • Format: (000) 000-0000.
  • Preferred Method of Contact*

  • Family Attendance Information

    How many family members will be attending?

  • Family Member Information

    Please list everyone attending

  • Family Member 1

  • Family Member 2

  • Family Member 3

  • Family Member 4

  • Family Member 5

  • Loss Information

  • How long ago did the death occur?*
  • Was this person receiving hospice services?*

  • Medical and Safety Information

  • Does anyone attending have any allergies?*
  • Does anyone attending have dietary restrictions?*
  • Does anyone attending have medical conditions we should be aware of?*
  • is anyone attending currently taking medications that may require support, reminders, or special considerations during the workshop?*

  • Please note: Camp Braveheart staff and volunteers do not administer medications. Parents/guardians remain responsible for medication administration and supervision of their children.

  • Emergency Contact Information

  • Format: (000) 000-0000.

  • Workshop Support

  • Acknowledgement

    I certify that the information provided is accurate and complete to the best of my knowledge.
  • Date
     - -

  • Camp BraveHeart Family Workshop

    Participation Agreement & Consent

  • Family Workshop Model

    Camp BraveHeart Family Workshop is a family-centered grief support program. Parents, guardians, or designated caregivers are expected to remain on-site and are responsible for supervising their children throughout the workshop.

    Camp BraveHeart is designed to provide grief education, peer support, and remembrance activities. It is not a substitute for mental health treatment, crisis intervention, or medical care.

    Emotional Safety

    Workshop activities may involve discussions of grief, loss, memories, and emotions that can be difficult or activating. Participants are encouraged to participate at their own comfort level and may take breaks as needed.

    Medical Care

    An RN will be available on-site for consultation and emergency response if needed. Parents/guardians remain responsible for:

    • Administering medications
    • Managing medical conditions
    • Supervising children
    • Providing any necessary medical supplies

    In the event of a medical emergency, staff may contact emergency medical services

  • Photography & Media Release

  • Please select one:*

  • Respectful Community Agreement

    To help create a safe environment, participants agree to:

    • Treat others with kindness and respect.
    • Honor different grief experiences.
    • Use appropriate language and behavior.
    • Respect confidentiality of stories shared by others.
    • Follow staff and volunteer directions.

    Confidentiality

    Participants are encouraged to respect the privacy of others attending the workshop. While staff and volunteers will strive to maintain confidentiality, confidentiality among participants cannot be guaranteed.

    Liability Release

    I understand that participation in Camp BraveHeart Family Workshop is voluntary.

    I release and hold harmless Hospice of Northeast Georgia Medical Center, Camp BraveHeart, its employees, volunteers, sponsors, and partners from liability for injuries, losses, or damages that may occur during participation except where prohibited by law.

    Consent

    I have read and understand the information above and give permission for myself and my family members listed on the registration form to participate in Camp BraveHeart Family Workshop.

  • Date
     - -
  • Should be Empty: