Camp Erin Tampa Bay 2020 - Camper Application  

Camp will be held from Friday, Feburary 28th – Sunday, March 1st, 2020 at Word of Life Florida in Hudson, FL.

Suncoast Kids Place will be hosting Camp Erin Tampa Bay which is a transformational weekend camp specifically designed for kids and teens, ages 6-17, who have experienced the death of a significant person. Camp Erin combines traditional, fun camp activities with grief education and emotional support, free of charge for all families. Led by grief professionals and trained volunteers, Camp Erin provides a unique opportunity for youth to increase levels of hope, enhance self-esteem, and especially to learn that they are not alone.

Campers will be chosen on a first come first serve basis with priority given to new campers*.  A family interview is required for all campers.  Acceptance status will be communicated after the family interview.  Camp space is limited.

*Campers that have previously attended any Camp Erin will automatically be added the waitlist.  Please verbally inform the staff if your child has experienced a significant death since attending.

For more information, please call (813) 990-0216, or go to www.suncoastkidsplace.org/camperin.


This application will take about 20-30 minutes to complete.
Items with an asterisk (*) are required fields.

Submission of this application does not constitute acceptance into Camp Erin Tampa Bay.

NOTE: This application is for one camper, please fill out and submit another application for each subsequent camper.

CAMPER INFORMATION


PARENT/LEGAL GUARDIAN: Any guardian listed on this form can receive information about the program and about the camper. (If legal guardian is not the biological parent, please provide custody paperwork)


Parent / Legal Guardian 1


Parent / Legal Guardian 2 (if applicable)


BEREAVEMENT HISTORY


CAMPER BEHAVIOR


CAMP INFORMATION


DEMOGRAPHICS (This information will be used for grant applications, research projects, and to better serve the community)


CAMPER MEDICAL INFORMATION: Please fill out to the best of your knowledge. Camp staff and/or camp nurse may call to follow up. The following information will be reviewed with the parent/guardian and the camp nurse on the first day of camp.


EMERGENCY CONTACTS: Please list two people other than parents/guardians to contact in case of emergency at camp.


CAMPER MEDICATION INFORMATION: Please list all of your camper's current long-term medications. We understand that these might change before camp. All medications must be in original container with camper's prescription.


Family Interview


By writing my name below I am certifying that all information in this application to be true, complete, and correct to the best of my knowledge and belief. I am also certifying that I am the legal parent/guardian of the above named camper.


I am also authorizing Eluna and Suncoast Kids Place to contact me by phone, text, and email with information about Camp Erin and Suncoast Kids Place.


I understand that there will be more forms to fill out and a family interview prior to my child's acceptance into Camp Erin Tampa Bay.