Camp HOPE, Inc. · Adult Registration Form

Contact Information

Name

*

First Name

Last Name

Email

*Email is the main source of communication between Parent/Guardian and Camp HOPE.

Verify Email

Phone

*

Address

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

County

Which camp are you registering for?

How did you hear about Camp HOPE?

Transportation Assistance Needed?

*

Camper Information

Name(s) and age(s) of your child(ren) attending Camp HOPE this weekend:

*

My gender or gender identity is best described as:

If you selected "Another gender not listed" for your child's gender or gender identity, please describe:

Pronouns

Select all that apply

She/Her

He/Him

They/They

My Race/Ethnicity can be best described as:

Select all that apply

American Indian or Alaska Native

Asian

Black or African American

Native Hawaiian or Other Pacific Islander

White

Hispanic or Latina/o/x

Middle Eastern or North African

Another race/ethnicity not listed

If you selected "another race/ethnicity not listed" for your race/ethnicity please describe:

Do you have any medical concerns or allergies we should be aware of? If yes, please describe:

Please tell us about your hobbies and interests:

Shirt Size

*

Small

Medium

Large

XL

XXL

3XL

Would you prefer to stay in a cabin with:

*

Information about the death of your loved one

Name of the person who died

*

First Name

Last Name

Age of person who died

Date and cause of death

*

Relationship of the person who died

*

Please describe your relationship with the person who died:

*

If you have lost more than one loved one, please add their information here:

Name, age, relationship to you, date of death, how the person died, and any other information you'd like us to know

Please describe changes in your family since the death:

Please describe your relationship with your surviving children:

Signature

*

The primary emphasis of Camp HOPE for adults is to provide an opportunity to share your experiences, make connections with others who have experienced similar losses, learn coping strategies and above all relax and enjoy nature. Camp HOPE and the programs presented are not intended to be used as a substitute for physician or psychiatric care. Participants understand that by enrolling they are agreeing to take part in the retreat voluntarily and remain responsible for their own physical and emotional choices. By signing this registration you are agreeing to release and hold harmless Camp HOPE and its representatives from any and all liability. All information is confidential.

Date

*

(mm/dd/yyyy)