Clone of TCFH and BOTS Waiver/Release/Intake 2024-2027
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  • CAMP HOPE for grieving teens

    Camp Hope is an overnight camp for grieving youth ages 12-18. Families must also participate in a readiness assessment prior to camp, to determine whether camp is a fit for the youth at this time. Application confirmation receipt does not guarantee admission to camp. Readiness interview must be conducted in order to make this determination. Please reach out to Senior Program Manager with any questions sandy@collectiveforhope.org

  • Youth Drop-Off Programming (Ages 12-18 only)

    Participants must be 12 years old, or turn 12 within one month of the start of camp. Exceptions may be granted at the discretion of staff, based on prior experience with the youth.

  • Technology

    For the best experience filling out this registration form, we recommend using the Google Chrome browser on a desktop or laptop computer. If you're experiencing issues on a mobile device, please try switching to a desktop.
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  • Caregiver Demographics

    By disclosing the following demographics, you are helping us apply for grants/funding that keep our programs free and/or accessible to everyone regardless of their ability to pay. Your personal information is kept confidential and is not reported alongside the details shared in this section. Thank you for whatever information you are comfortable sharing for this purpose.
  • Caregiver: Are you of Hispanic, Latino, or Spanish origin?*
  • Caregiver: Annual household income (This information is used grant reporting and will be kept confidential. Demographics will only be reported anonymously and separate from any identifying information such as name.)*
  • Caregiver: Is your child(ren) eligible for free or reduced lunch at school?*

  • Information about the person who died

    Please tell us about your child's special person(s) below
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  • Cause of death*

  • Child(ren) Information

    Please fill out the following for each child (age 10-18) who will be attending group. This is collected for record keeping and reporting. By disclosing the following demographics, you are helping us apply for grants/funding that keep our programs free and/or accessible to everyone regardless of their ability to pay.
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  • Child 1: Is this child of Hispanic, Latino, or Spanish origin?*
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  • Did Child 1 live with the person who died?*

  • Health & Mental Health History

    Please note that we are not therapists or counselors. We offer peer support and trained staff, volunteers, facilitators. If your child exhibits behaviors that go against our policies/expectations/group norms, we may call the caregiver listed above, and if they do not answer, we will call the emergency contact on file. Please make yourself available by phone/text during while your child(ren) are in our care.
  • Does Child 1 have any of the following? (Please check all that apply). This information helps us better support them in our programming.*

  • We may offer snacks and drinks at events. Please list any/all allergies or dietary needs for Child 1. If your child has severe allergies, please be sure they have an EpiPen with them in case of emergency.*

  • What type of support does Child 1 have outside of this programming?

  • Are you registering another child?*

  • Child 2 Information

    Please fill out the following for each child (age 10-18) who will be attending group. This is collected for record keeping and reporting. By disclosing the following demographics, you are helping us apply for grants/funding that keep our programs free and/or accessible to everyone regardless of their ability to pay.
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  • Child 2: Is this child of Hispanic, Latino, or Spanish origin?*
  • Browse Files
    Cancelof
  • Did Child 2 live with the person who died?*

  • Health & Mental Health History

    Please note that we are not therapists or counselors. We offer peer support and trained staff, volunteers, facilitators. If your child exhibits behaviors that go against our policies/expectations/group norms, we may call the caregiver listed above, and if they do not answer, we will call the emergency contact on file. Please make yourself available by phone/text during while your child(ren) are in our care.
  • Does Child 2 have any of the following? (Please check all that apply). This information helps us better support them in our programming.*

  • We may offer snacks and drinks at events. Please list any/all allergies or dietary needs for Child 2. If your child has severe allergies, please be sure they have an EpiPen with them in case of emergency.*

  • What type of support does Child 2 have outside of this programming?

  • Are you registering another child?*

  • Child 3 Information

    Please fill out the following for each child (age 10-18) who will be attending group. This is collected for record keeping and reporting. By disclosing the following demographics, you are helping us apply for grants/funding that keep our programs free and/or accessible to everyone regardless of their ability to pay.
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  • Child 3: Is this child of Hispanic, Latino, or Spanish origin?*
  • Did Child 3 live with the person who died?*

  • Health & Mental Health History

    Please note that we are not therapists or counselors. We offer peer support and trained staff, volunteers, facilitators. If your child exhibits behaviors that go against our policies/expectations/group norms, we may call the caregiver listed above, and if they do not answer, we will call the emergency contact on file. Please make yourself available by phone/text during while your child(ren) are in our care.
  • Does Child 3 have any of the following? (Please check all that apply). This information helps us better support them in our programming.*

  • We may offer snacks and drinks at events. Please list any/all allergies or dietary needs for Child 3. If your child has severe allergies, please be sure they have an EpiPen with them in case of emergency.*

  • What type of support does Child 3 have outside of this programming?

  • Are you registering another child?*

  • Child 4 Information

    Please fill out the following for each child (age 10-18) who will be attending group. This is collected for record keeping and reporting. By disclosing the following demographics, you are helping us apply for grants/funding that keep our programs free and/or accessible to everyone regardless of their ability to pay.
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  • Child 4: Is this child of Hispanic, Latino, or Spanish origin?*
  • Did Child 4 live with the person who died?*

  • Health & Mental Health History

    Please note that we are not therapists or counselors. We offer peer support and trained staff, volunteers, facilitators. If your child exhibits behaviors that go against our policies/expectations/group norms, we may call the caregiver listed above, and if they do not answer, we will call the emergency contact on file. Please make yourself available by phone/text during while your child(ren) are in our care.
  • Does Child 4 have any of the following? (Please check all that apply). This information helps us better support them in our programming.*

  • We may offer snacks and drinks at events. Please list any/all allergies or dietary needs for Child 4. If your child has severe allergies, please be sure they have an EpiPen with them in case of emergency.*

  • What type of support does Child 4 have outside of this programming?

  • Waivers

  • Artwork, Photographs, and Video Images Statement

    I authorize The Collective for Hope and/or assignees or licensees to use art, photographs and/or video images of my child for reproduction for promotional, illustrative, marketing, social media, or educational purposes. I understand that the above activities will not result in any profit, and that I will not receive any monetary compensation. Permission is granted to make changes or alterations and to use my child’s name or a fictitious name in editorial works or advertising. I understand that The Collective for Hope takes photographs of the members and families during programs and may share the images in program communications. I give permission and understand that my child and family may be photographed and/or videotaped at The Collective for Hope programs and events.

  • Emergency Medical Treatment Release

    I agree to have my child receive any emergency medical services deemed necessary by the authorities in charge. I understand that the resulting expenses will be my responsibility as the child’s parent/guardian. I further agree to release, discharge and indemnify The Collective for Hope, Band of the Strong, its Officers, Board of Directors, Employees and Agents from any and all liability, damages, claims or causes of action, arising out of or in any way connected to the administration of emergency medical services.

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    The Collective for Hope Outings/Activities Release

    I agree to release and forever discharge The Collective for Hope, Band of the Strong, its Officers, Board of Directors, Employees and Agents, and all vessels and facilities owned and/or operated by The Collective for Hope (hereinafter “Released Parties”) from any and all liability, damages, claims or causes of action, arising out of or in any way connected with the minor’s participation in The Collective for Hope and Band of the Strong outings and activities. I further agree to indemnify the Released Parties and hold them harmless from any liability, damages, claims, or causes of action made or brought by the said minor or by anyone on behalf of the minor as a result of or in any way connected with the minor’s participation in The Collective for Hope and Band of the Strong outings and activities. The undersigned acknowledges that the outings and activities addressed by this release are completely VOLUNTARY.

     

    I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to myself and/or my child(ren) (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I or my child(ren) may experience or incur in connection with my attendance or my child(ren)’s attendance at in-person events with The Collective for Hope and Band of the Strong.  On my behalf and/or on behalf of my child(ren), I hereby release, covenant not to sue, discharge, and hold harmless The Collective for Hope, Band of the Strong, its employees, directors, contractors, program partners, volunteers, agents, and representatives of and from the claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto.  I understand and agree that this release includes any claims based on the actions, omissions, or negligence of The Collective for Hope, Band of the Strong, its employees, directors, contractors, program partners, volunteers, agents, and representatives, before, during, or after participation in any in-person appointments with The Collective for Hope. 

     

    Lost or Stolen Items

    The Collective for Hope, Band of the Strong, its employees, directors, contractors, program partners, volunteers, agents, and representatives will not be responsible for damaged, broken, lost or stolen items of any kind. Valuable items should be left at home.

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  • Authorized for drop-off / pick-up

    Please list all persons authorized to drop and pick up youth from activities

  • Confidentiality & Mandatory Reporting

  • Participant’s Role 
    I can share only what I said, what I felt, or what I learned. I will be respectful of other group members by not sharing what other members have shared, felt, or how they have acted. I may not talk about another group member outside of the group itself. 

     

    Facilitator/Staff Role

    We respect each and everyone's right to privacy and confidentiality and we shall make sure to maintain it that way. However, please understand that this is not absolute and is limited to provide for by law. Everyone in the state of  Nebrasksa is a Mandatory Reporter. Confidentiality exceptions while rare are as follows: Threatening one's self or another that may result in physical harm;An act of physical or emotional abuse against a child or any person;Sexual abuse against a child where the child is living with the abuser;Whenever we are summoned by court order to disclose information against a participant. 

  • Expectations/Communications

    We are not counselors or therapists and we do expect youth to abide by our policies and group norms/"rules"

  • Our programs are open to everyone regardless of ability to pay. If you would like to add a donation to support this and other ongoing programming, you can do so HERE.

    We also accept in-kind snack, beverage, supply donations. Thank you for your kind support! 

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