Camp Good Grief Application – Camper

Camper's Name:*
First Last
Nickname:
I want to go to Camp Good Grief because: .......(Mark as many as you need to)*
- I miss the person that died
- I would like to meet other kids that have had a special person in their life die.
- I would like to learn ways to cope with death
- My parent/guardian(s) are making me go to camp
- I would like to get away from home for a while and have fun with kids my own age
Other (explain):
What are some of your fears about going to Camp Good Grief?
- I feel uncomfortable about talking with others about death
- I am afraid I won't have anything in common with the other kids
- Maybe the other kids won't like me
Other (explain):
Bereavement History
The name of the person who died is...*
This person was my...*
My loved one died from...*
My favorite thing to do with them was...*
My favorite memory of my loved one is...*
My loved one really liked...*
The thing I miss the most about my loved one is...*
My loved one didn't like...*

Bereavement History