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Youth/Child Registration Form

This form will take you about 10-15 minutes. The information you share will help us provide the best expereince for your child at Camp HOPE. If you have any questions or concerns, please email or call our Executive Director, Maria Loy, at or (608)-621-0633.

Please note, the medical history portion asks for your physician's name and phone number, the date of your child's last Tetanus vaccination, insurance information (if applicable), and any medication (with dosage) your child will need to take at Camp HOPE. You may want to have that information readily available before starting this form.

Contact Information

Please note, winter camp is only for campers who have previously attended a fall or spring camp.

Camper Information


Select all that apply
Select all the apply

Are they shy, outgoing, loving, caring, kind, love to be around people, overwhelmed by loud noises, etc? What do you love about your child? What do they excel at? What do they struggle with?

*We will do our best to accommodate this request. Please know that if we do not have enough campers who select this option in your age group we will be reaching out to make an individual plan to support your child’s safety and wellbeing. This option is meant to provide safety for our children who may feel unsafe in a gendered cabin, not necessarily for children who would like to sleep cabins with their siblings. If this is a concern for you, please reach out to Maria to talk through options.

Information About the Person Who Died

Step-parent, foster parent, teacher, family friend, etc...

**Please be sure the camper is aware of the actual cause of death, as it will be shared at camp.**

Name, age, relationship to child, date of death, and how the person died

behaviors, remarriage, aggression, anxiety, sleep issues, mental health concerns, suicidal thoughts, hospitalizations, etc.

I have read, understand, and agree to abide by the operating policy of Camp HOPE

The primary emphasis of Camp HOPE is to provide an opportunity to share 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.


Authorization to Disclose Camper Photos and Videos

I authorize Camp HOPE to release my camper’s image and likeness taken during the Camp HOPE program. The purpose of this disclosure is to promote the program, and/or fundraise for Camp HOPE. The image and/or likeness can also be used for Camp HOPE’s marketing efforts, including, but not limited to, a brochure or video promoting Camp HOPE, or other educational programs or fundraising events for Camp HOPE. Right to Revoke: I understand that I have the right to revoke this Authorization at any time by giving Camp HOPE written notice of the revocation. I understand that any revocation will not apply to any disclosure that has already been made in reliance upon this Authorization. I understand that I have the right to refuse the use of my camper’s image and likeness below and that my refusal will not affect my child’s experience. I understand that I may request a copy of this signed Authorization. A copy of this document is valid as an original. The original is not required to be shown. The Authorization will expire on December 31, 2033.

Camper Health History Form

This form is required and is to be filled in by parent/guardian


Please check all that apply

Please check all that apply

Please include dates


This health history is correct and I hereby give permission to the medical personnel selected by the camp director to order x-rays, routine tests, treatment and necessary transportation for me/my child. In the event I cannot be reached in an emergency, I hereby give permission to the physician selected by the camp director to secure and administer treatment, including hospitalization for me/my child. *MUST be completed for Attendance*


Medication Information

**Please note: Parent/guardian will be contacted for any major medical concern that occurs at camp. Be sure we have a phone number to be able to reach you this weekend.

All prescription medications must be brought to camp in their original, properly labeled containers. The container should have the correct number of pills for this weekend only. Any changes from those on the container must be verified in writing by a physician. Be sure the expiration date is current.

All medication will be administered by health office staff. Campers will not be allowed to have medication in their cabins. Inhalers may be self-administered with parent/guardian permission.