2020 Camp Lolo - Camper Application
Thanks for your interest in Camp Lolo. Camp Lolo is a 2-day, day camp held at Coolwater Ranch in Meridian, ID each summer. The 2020 camp will be on Friday, June 19th & Saturday, June 20th. Please consider the following guidelines before / as you complete this Camper Application.
To be eligible to attend Camp Lolo, campers must:
1) Be between the ages of 6-17 on June 19, 2020
2) Be struggling with grief related to the death of a loved one
3) Be able to attend both days of camp
4) Priority for camp attendance will be given to kids/teens/campers who have not previously attended camp and/or who have not had the benefit of professional support. Kids & teens who have previously attended and/or received professional support will be able to attend if/as space permits.
Parents and Guardians of campers are not allowed to volunteer during camp. Parents/Guardians of campers must be willing to: arrange for and/or provide transportation to/from camp site for their child/camper; provide accurate and complete information about camper; sign consent & permission forms. Parents and Guardians are also strongly encouraged to participate in a Parent Meeting and Camp Dinner & Closing Ceremony on the afternoon / early evening of Saturday, June 20th.
If your potential camper(s) meet(s) the criteria above, please proceed with this application. Please complete separate / individual applications for each potential camper.
Camper Last Name
Camper First Name
What is the best first name or nickname to use on your camper's name tag?
Camper Date of Birth:
Parent / Guardian Contact Information:
Parent/Guardian Last Name(s):
Parent/Guardian First Name(s):
Parent/Guardian Phone Number(s):
Parent/Guardian Address (Please include city, state, & ZIP):
Alternate / Emergency Contact (to be used if camp staff are unable to reach you in an emergency) :
Emergency Contact Name:
Emergency Contact's Relationship to Camper:
Emergency Contact's Phone Number:
Camper - General Information:
How old will the camper be on June 19, 2020?
What is the camper's gender?
Prefer not to say
What is the camper's t-shirt size?
Other - Please check this box if your child needs an adult size shirt, then indicate size needed below.
If "other" please indicate preferred size below:
What is the camper's ethnicity / ethnic background? (Optional)
Where does the camper attend school?
What grade is he/she in?
What are some of the camper's interests, unique skills, and/or special talents?
Camper - Medical Information
Is the camper up to date on all immunizations & vaccines?
Does the camper have any medical, physical, behavioral, or mental health issues or limitations? If yes, please list & explain. If no, please type N/A.
Please list any medications the camper takes that he/she will need to take while at camp. Please list specific name, dose, and frequency. If no medications are needed, please type N/A.
Does the camper have any allergies or hypersensitivities? If yes, please explain, if not, please type N/A.
Does the camper have any dietary/food restrictions and/or allergies? If yes, please explain. If not, please type N/A.
Information about Camper's Loss & Grief
Please list the first & last name of the loved one who passed away:
What was the relationship of the loved one to the camper?
How old was the loved one at time of death?
Date of Death (MM/DD/YY):
What was the cause of death?
Was the camper present at the time of death? If yes, please explain circumstances - if not, please type "no".
Please describe how the camper has been coping since the death and managing his or her grief.
Has the camper experienced multiple losses or deaths? If yes, please explain (please include information about who has died and what their relationships were to the camper).
Has the camper received any professional support to help with his/her grief?
Yes, currently receiving professional support
No, has never received professional support
Received some professional support - but not currently utilizing
Has the camper previously attended Camp Lolo? If so, what year?
Have there been any other big changes or stressors in the camper's life? (divorce, remarriage, relocation/move, illness, etc.)? If yes, please explain. If not - please list "no".
Is there any other information you would like to share about the camper, his or her loss, and/or his/her current coping skills that might better help us support him or her at camp?
How did you hear about Camp Lolo?
** I hereby certify that the information provided in this application is accurate to the best of my knowledge.**
**I want my/this child/teen to participate in Camp Lolo activities and authorize him/her/other to take part in all camp activities (hiking, kayaking, swimming, petting horses and dogs/service animals, arts & crafts (including use of scissors, paint, glue, etc.), discussions and activities designed to help identify and process feelings and common reactions to grief.**
**I give camp Lolo permission to use photographs and/or video of my child in the promotion and publicity of camp Lolo on Facebook, the camps website, and/or any materials generated by Camp Lolo.**
**I am willing to be contacted for updates with Camp Lolo information.**
**I waive any claims against Camp Lolo, except for claims arising from negligence or willful acts of these agents that may arise from participation in the activities of Camp Lolo.**
**I understand that if my child attends camp that I cannot serve as a volunteer during camp.**
Please type your name and today's date in the space below to indicate your agreement with and understanding of the above consent information.
Thank you for your interest in Camp Lolo! We will be in touch as we review applications with any questions we have and to let you know if we will be able to serve your potential camper(s) and about next steps.
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service