2019 Camper Application Camp Erin Boston
There will be one session of Camp Erin Boston in 2019.


Camp Erin Boston Session will be held
Friday, August 16, 2019 through Sunday, August 18, 2019
at Camp Avoda in Middleboro, MA.


Camp Erin Boston is offered FREE OF CHARGE to all campers.

Who can attend Camp Erin?
-Any child or teen, ages 6-17 who has experienced the death of someone close to them in their lifetime.
-It does not matter how long ago the death occurred.
-It does not matter if the deceased was a participant of CareGroup Parmenter Home Care and Hospice.
-It does not matter where you live, as long as you are willing to travel to all events.

APPLICATIONS ARE DUE BY MAY 1, 2019. Applications are accepted on a rolling basis until we are full (50 campers). Applicants will automatically be placed on a wait -list once capacity is reached.

Due to space limitations, we can only accept 50 campers per session. Preference is given to those who have never attended Camp Erin.

-Interviews will be conducted March-June 2019. We will contact you to schedule an interview.

-Acceptance letters will be sent out by mid-June

-The Ice Cream Social is a REQUIRED event for all accepted campers.
It will be held on SUNDAY, July 21, 2019, 3-5 PM. Place TBA.

- A Reunion will be held in Mid- October 2019. Date and place TBA
________________________________________________________________________________________________________________________
Mt. Auburn Hospital/Camp Erin Boston welcomes all members of our community regardless of age, ancestry, color, disability, gender, gender identity or expression, genetic information, handicap, military service, national origin, race, religion, sex, or sexual orientation or source of payment for your care.

Camper's First Name *
Your answer
Camper's Last Name(s) *
Your answer
Camper's Date of Birth *
MM
/
DD
/
YYYY
Camper's Age *
Age camper will be by August 16, 2019
Your answer
Camper's Sex *
Ex: female, male, MtF female, FtM male, intersex, non-binary
Your answer
Parent or Legal Guardian's First Name *
Your answer
Parent or Legal Guardian's Last Name(s) *
Your answer
What is your relationship to the camper? *
If you choose 'other' please explain.
Required
Street Address *
Your answer
City *
Your answer
State *
You may apply from any state as long as you are willing to travel to all camp related events. You can look for a Camp Erin in your state at www.elunanetwork.org .
Your answer
Zip Code *
Your answer
Cell Phone Number *
Your answer
Home Phone Number
Your answer
Work Phone Number
Your answer
Email Address *
Your answer
Email Address- please confirm *
Your answer
Is your household considered a low income household? *
Defined as less than $36,900 gross household income per year.
Camper's Ethnicity *
Check all that apply.
Required
Camper's T-Shirt Size *
Emergency Contacts
Please list two adults, other than the parent or guardian, to contact in case of an emergency.
Emergency Contact 1 Name *
Your answer
Emergency Contact 1 Phone Number *
Your answer
Emergency Contact 1 Relationship to Camper *
Your answer
Emergency Contact 2 Name *
Your answer
Emergency Contact 2 Phone Number *
Your answer
Emergency Contact 2 Relationship to Camper *
Your answer
Camper's Pediatrician's Name *
Your answer
Camper's Pediatrician's Phone Number *
Your answer
How did you hear about Camp Erin Boston? *
If you heard about Camp Erin from a person/school/organization please write the name of the person/school/organization below. If not, please write N/A. *
Your answer
Are you (parent/legal guardian) a member of the armed forces?
Do you or the camper know anyone attending or applying to Camp Erin Boston (other family members, volunteers, staff or another camper)? *
Please specify below or write No.
Your answer
Please list any special skills, talents or interests of the camper. *
Examples: Legos, reading, writing, sports, art, dance, music, favorite subjects in school, etc.
Your answer
Any dietary restrictions, food allergies, or preferences? *
If none, please write "none".
Your answer
Any Allergies? (Stings, Medicinal, Environmental?) *
If none, please write "none".
Your answer
Please list ALL medications (over the counter and prescribed) to be administered at camp. *
Specify the name, dose, time to be given and any instructions needed. If none, please write "none".
Your answer
Is the camper up to date on all immunizations and physical exams? *
Any difficulties with staying away from home for two nights? *
If "no", please state "no". If "yes" please explain.
Your answer
Has the camper ever run away from home? *
If "no", please state "no". If "yes" please explain.
Your answer
Any inappropriate physical and/or sexual behaviors we should be aware of? *
If "no", please state "no". If "yes" please explain.
Your answer
Has the camper ever discussed or attempted suicide? Caused harm to self or others? *
If "no", please state "no". If "yes" please explain.
Your answer
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