Camp Erin Orange County 2019 Camper Application
Thank you for your interest in Camp Erin Orange County 2019. This year's camp will be held from Friday, May 3 through Sunday, May 5 in Orange, CA.

Each Camper Application will take approximately 15-20 minutes to complete. Please complete one Camper Application for each child interested in attending. The application includes general interest questions, camper and parent/guardian information, and bereavement history.

Because we want to ensure the best possible experience for every Camp Erin participant, each Camper Application will be reviewed in detail to determine their appropriateness for this specialized camp. An in-person Camp Orientation and Family Meeting is required for all interested campers and their parent/legal guardian prior to acceptance. Our staff will contact you to arrange times and location for this specialized meeting. Campers will be accepted on a first come, first serve basis, following completion of application and Family Meeting. However priority will be given to new campers.

CAMPER INFORMATION
Child's First Name *
Your answer
Child's Formal First Name
If different than above
Your answer
Child's Last Name *
Your answer
Child's Date of Birth *
Please use this format MM/DD/YYYY
Your answer
Child's Gender *
Child's Age *
Please indicate age child will be on May 3, 2019
Name of School *
Your answer
School Grade *
Please indicate your child's current grade level
Ethnicity - Child
Used for demographic purposes only.
Overnights *
Has your child attended an overnight camp or spent the night away from home?
Camp Interest *
Which best indicates your child's thoughts about coming to camp?
Child's Interests/Hobbies *
Your answer
Prior Camp Erin *
Has your child attended any Camp Erin before?
Prior Camp Erin
If so, when and where? (years and locations)
Your answer
T-shirt size *
Please indicate your child's t-shirt size
Siblings also applying for camp
You will complete a full camper application for each interested camper, however this helps us match family applications. Please list the first and last name of all additional interested campers
Your answer
PARENT/LEGAL GUARDIAN INFORMATION
Parent/Legal Guardian FIRST Name *
Your answer
Parent/Legal Guardian LAST Name *
Your answer
Relationship to camper? *
Secondary Parent/Legal Guardian FIRST Name
Your answer
Secondary Parent/Legal Guardian LAST Name
Your answer
Secondary Parent/Legal Guardian Relationship to camper?
Home Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Home Phone
Please use this format 555 555-1234
Your answer
Work Phone
Please use this format 555 555-1234
Your answer
Cell Phone
Please use this format 555 555-1234
Your answer
Best Phone Number *
Which number is best to reach you for questions/to set up family meeting?
Parent/Legal Guardian E-mail Address *
Your answer
Language *
Primary language of parent/guardian
Emergency Contact *
Please list 2 people, other than you, that we may contact in case of an emergency at camp. Please list name, contact number, and relationship to camper
Your answer
IF THE PERSON COMPLETING THIS FORM IS SOMEONE OTHER THAN THE PARENT OR LEGAL GUARDIAN, PLEASE PROVIDE THE FOLLOWING INFORMATION:
First and Last Name
Your answer
Relationship to the family
Your answer
Phone Number
Your answer
Email Address
Your answer
DEMOGRAPHIC INFORMATION
How did you hear about Camp Erin Orange County? *
Indicate the primary way you heard about camp.
Ethnicity - Parent/Guardian
Used for demographic purposes only
Family Income
Used for demographic purposes only
Military Affiliation *
Is the PARENT/GUARDIAN on active duty or a veteran?
Branch of Service
If you answered YES to above question, please indicate the branch of service.
GRIEF & LOSS INFORMATION
Name of person who died *
Your answer
Date of Death *
Please use this format MM/DD/YYYY
Your answer
Age of deceased at time of death *
Your answer
Relationship to Child *
The deceased was the camper's:
Cause *
Please indicate the cause of death
Military Affiliation - Deceased *
Was the deceased on active duty or a veteran?
Branch of Service
If you answered YES to above question, please indicate the branch of service.
Facts of the Death *
Has your child been told the facts regarding the cause of death?
If no to above question, please share situation briefly.
Your answer
Age of child at time of death *
Your answer
Present at death? *
Was the child present at the time of death?
Experience with Death *
Was this the child's first experience with death?
Memorial Attendance? *
Did your child attend the funeral or memorial service?
Household *
Did your child live in the same household with the deceased?
Relationship with deceased? *
How would you describe your child's relationship with the deceased?
Family Communication *
How would you describe your family's predominant communication regarding the death?
Child's Communication *
How would you describe your child's predominant communication regarding the death/loss?
Child's Reactions to Loss - Emotional *
Check all that apply.
Required
Child's Reactions to Loss - Physical *
Check all that are true for your child since the death.
Required
Child's Reactions to Loss - Thoughts *
Check all that are true for your child since the death.
Required
Child's Reactions to Loss - Behaviors *
Check all that are true for your child since the death.
Required
Stressors *
Have there been any other significant stressors in your child's life since the death (divorce, remarriage, finances, moving, other losses)
Your answer
Abuse *
Has your child ever suffered any abuse?
If Yes, please briefly explain.
Your answer
Medical *
Although you will complete a complete medical history and medications list closer to camp, please let us know here if your child has medical issues (including medications), concerns, needs we need to discuss with you before or at the family meeting.
Your answer
Counseling *
Has your child ever seen a mental health counselor?
If YES, Briefly state reason for seeing counselor
Your answer
Concerns for your child *
Do you have any concerns for your child at the moment?
Your answer
Concerns about attending camp *
Do you have any concerns about your child attending camp?
Your answer
What more would you like us to know?
Your answer
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