Camp Registration

    Register for CAMP KANGAROO


    SELECT CAMP LOCATION *

    HOW DID YOU HEAR ABOUT CAMP? *

    NAME OF CHILD ATTENDING *

    CHILD'S STREET ADDRESS *

    CHILD'S CITY *

    YOUR NAME, PARENT OR GUARDIAN *

    TELEPHONE *

    EMAIL *

    EMERGENCY CONTACT*

    ALLERGIES *

    MEDICAL CONDITIONS *

    SPECIAL PERSON(S) WHO DIED: FULL NAME *

    RELATIONSHIP *

    AGE OF CAMPER AT THE TIME OF THE LOSS *

    BRIEFLY DESCRIBE THE RELATIONSHIP BETWEEN THE CAMPER AND THE DECEASED.

    DOES YOUR CHILD HAVE DIFFICULTY WITH ANY OF THE FOLLOWING AREAS? CHECK ALL THAT APPLY. NoneSleepingEatingSchoolRelationships
    DID YOUR CAMPER RESIDE WITH THE PERSON WHO DIED?*

    IS YOUR CAMPER CURRENTLY ATTENDING SCHOOL IN PERSON OR VIRTUALLY?

    DOES YOUR CAMPER RECEIVE MEALS FROM SCHOOL FREE OF CHARGE?

    DOES THE CAMPER HAVE A COMPUTER THAT CAN BE ACCESSED DURING VIRTUAL CAMP KANGAROO (EXPECTED TO BE 1-2 HOURS PER WEEK FOR SEVERAL WEEKS)?

    DOES THE CAMPER HAVE A PHONE THAT CAN BE ACCESSED DURING VIRTUAL CAMP KANGAROO (EXPECTED TO BE 1-2 HOURS PER WEEK FOR SEVERAL WEEKS?)

    DOES THE CAMPER HAVE A INTERNET ACCESS THAT CAN BE ACCESSED DURING VIRTUAL CAMP KANGAROO (EXPECTED TO BE 1-2 HOURS PER WEEK FOR SEVERAL WEEKS?)

    VIRTUAL CAMP KANGAROO IS EXPECTED TO BE HELD EITHER ON A WEEKEND OR AN EVENING DURING THE WEEK, IS AN ADULT ABLE TO BE HOME WITH THE CAMPER DURING THIS TIME?

    ARE THERE ANY LANGUAGE, DISABILITY, OR OTHER NEEDS, FAMILY CUSTOMS, OR CULTURAL ASPECTS TO YOUR CHILD'S GRIEVING THAT WE SHOULD BE AWARE OF?

    PLEASE PROVIDE US WITH ANY OTHER INFORMATION ABOUT YOUR CHILD THAT WILL BE HELPFUL IN PROVIDING A SUPPORTING CAMP EXPERIENCE.

    GENDER *

    AGE *

    T-SHIRT SIZE *




    Thank you

    Thank you on behalf of the Seasons Foundation Team and the patients and families your generous gift will help!