2025 Camp Erin Registration
Please fill out a separate form for each student
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Email *
Student's First Name *
Student's Last Name *
Student prefers to be called *
Gender *
If you selected other above, please clarify *
Date of Birth (MM/DD/YYYY) *
Age *
Grade *
Race/Ethnicity (We use this information to gather demographic statistics. Check all that apply) *
Required
School Name *
Parent/Guardian First Name *
Parent/Guardian Last Name *
Relationship to student *
Mailing Address *
City *
State *
Zip *
Cell Phone *
Best time to reach you? *
Preferred method of contact *
Emergency Contact #1 (Please list someone other than you to contact in case of emergency at camp) *
Emergency Contact #1: Relationship to camper *
Emergency Contact #1: Cell Phone *
Emergency Contact #2 (Please list someone other than you to contact in case of emergency at camp) *
Emergency Contact #2: Relationship to student *
Emergency Contact #2: Cell Phone *
Has student participated in any other Because Kids Grieve events/services before?         *
If yes, what dates did they attend? *
Does the student applicant qualify for or receive free or reduced lunch at school? *
How did you hear about Because Kids Grieve events/services (including Camp Erin)? (check all that apply) *
Required
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