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General Information
Please fill out a separate form for each student
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Email
*
Your email
For which Because Kids Grieve event are you wanting to register?
*
Kids2Kids (At Your School)
Kids2Kids (Boise)
Kids2Kids (Twin Falls)
Day Camp (Treasure Valley area)
Day Camp (Twin Falls)
Camp Erin Camp (Trinity Pines)
Tree Of Remembrance (Meridian)
Creating Holiday Memories (Twin Falls)
Kids2Kids Monthly Parent/Guardian Meeting (Twin Falls)
Kids2Kids Monthly Parent/Guardian Meeting (Treasure Valley area)
Participant's First Name
*
Your answer
Participant's Last Name
*
Your answer
Student prefers to be called
*
Your answer
Gender
*
Female
Male
Other
If you selected other above, please clarify
*
Your answer
Date of Birth (MM/DD/YYYY)
*
Your answer
Grade
*
Your answer
Race/Ethnicity (We use this information to gather demographic statistics. Check all that apply)
*
African-American
Native American
Asian
Caucasian
Native Hawaiian or other Pacific Islander
Hispanic/Latino(a)
Multi-Racial
Other
Required
School Name
*
Your answer
Siblings (list names & ages)
*
Your answer
Parent/Guardian First Name
*
Your answer
Parent/Guardian Last Name
*
Your answer
Relationship to student
*
Your answer
Mailing Address
*
Your answer
City
*
Your answer
State
*
Your answer
Zip
*
Your answer
Cell Phone
*
Your answer
Best time to reach you?
*
Morning
Afternoon
Evening
Preferred method of contact
*
Phone
Email
Emergency Contact #1 (Please list someone other than you to contact in case of emergency at camp)
*
Your answer
Emergency Contact #1: Relationship to camper
*
Your answer
Emergency Contact #1: Cell Phone
*
Your answer
Emergency Contact #2 (Please list someone other than you to contact in case of emergency at camp)
*
Your answer
Emergency Contact #2: Relationship to student
*
Your answer
Emergency Contact #2: Cell Phone
*
Your answer
Has student participated in any other Because Kids Grieve events/services before?
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Yes
No
If yes, what dates did they attend?
*
Your answer
Would you like to receive mailing about Because Kids Grieve events/services?
*
Yes
No
Does the student applicant qualify for or receive free or reduced lunch at school?
*
Yes
No
How did you hear about Because Kids Grieve events/services (including Camp Erin)? (check all that apply)
*
Because Kids Grieve
School (i.e. teacher, counselor, etc.)
Website
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Facebook
Friend/Acquaintance
Other:
Required
How many adults will be attending the adult session of Kids2Kids or Day Camp? (If this does not apply put NA)
*
Your answer
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