Camp Caring Application - WV Caring - Advanced Illness Care

CAMP CARING APPLICATION

A FREE ONE-DAY BEREAVEMENT CAMP FOR CHILDREN

August 16th, 2025

For children ages 6-14 and the adults who love them. Thank you for your interest in attending this year’s Camp Caring.

Camper and Family Information

Please complete the attached registration form below as soon as possible to secure your space. Incomplete information will cause a delay in processing your child’s application and may result in your child being unable to attend camp, as space is limited. Once your application has been reviewed and accepted, Camp Director/Bereavement Staff will interview your child. All information and material needed for camp will be provided through email or regular mail once your child has been accepted.

Please note this important information:

If your child requires special accommodations (i.e., dietary restrictions/physical limitations), please
let us know immediately. We will make every effort to accommodate special needs.
Please plan on bringing your child to camp. Arrival time will be provided with additional camp
information.
Adults are able to attend Camp as well and participate in the adult classes.
All campers can attend camp only once, so that others have the same opportunity.

To Volunteer: fill out the volunteer application click here

Camp Director: Emily Harden – eharden@wvcaring.org

Camper Application

1Introduction

2Camper & Grown Up Info

3Medical Info

4Consent

5Insights

Welcome to Camp Caring!

Please complete the registration form below. Once we receive your submission, the camp director will contact you with additional details and next steps.

Important Information:

Getting to Know Our Campers: We may reach out to speak with your child or their trusted loved one to better understand their experiences with grief and how we can ensure a meaningful camp experience.
Special Needs & Accommodations: If your child requires special accommodations (e.g., dietary needs or mobility assistance), please let us know as soon as possible. We strive to accommodate all campers.
Arrival Information: We ask that you plan to bring your child to camp. Mid-morning arrival times will be confirmed in your follow-up information.
Parents & Grownups Welcome: Concurrent sessions for adults will be available, focusing on processing grief and supporting children through their journeys.
Returning Campers: Campers from previous years are warmly invited to join us again!
Photography & Video: Photos and videos may be taken during camp activities. Please review the media consent and release information, and let us know if your child should not be photographed.

Contact Us:

Grief & Loss Services
Phone: 304-599-4200 (ask for grief and bereavement)
Email: campcaring@wvcaring.org

Camper Information

Name

First Last

Sex

Date of Birth

MM slash DD slash YYYY

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone

Shirt Size

School

Grade 24/25

Options:

The child has a second or different address where they receive mail.

Grown Up(s) will be attending camp with child

Mailing Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Parent/Grown Up Information

Name

First Last

Relationship to Child

Phone

Email(Required)

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Grown Up(s) Attending Camp With Child

List the grown up(s) attending with child here:

Click the plus icon to add additional grown ups.

Name

Relationship

Address

Phone

Shirt Size

Health History

Medical Complications

Check any below if your child has ever had any of the following medical complications.

Frequent ear infection

Diabetes

Epilepsy

Mononucleosis

Allergies

Check any of the following allergies that pertain to your child.

Allergies

Asthma

Food (please specify)

Hay Fever

Insect Stings

Poison Ivy

Penicillin

Other Drug (please specify)

Food Allergies(Required)

Drug Allergies(Required)

Last Tetanus Vaccination Date

MM slash DD slash YYYY

Activities that should be restricted or physical limitations:

Will your child be bringing any medication to Camp?

Yes

List of Medications(Required)

Medication Name

Dosage

Times Taken

Over the Counter Medicines

Please check over-the-counter medications that may be administered if needed:

Tylenol

Ibuprofen

Cough Syrup

Dramamine

Decongestant

Antacid

Polysporin/Hydrocortisone

Artificial Tears

Other (please specify)

Other Over the Counter Medicine(Required)

Your Name(Required)

First Last

Agreement

I give permission to West Virginia Caring to share the information provided in this form with the Camp Caring staff. I understand that by submitting this form, my digital agreement serves as my official authorization.

Medical Authorization

I verify that all medications brought to camp are listed on this form and that all medications must be turned in to the Camp Nurse. I authorize the Camp Nurse or designee to administer or dispense medications including over-the-counter medications.

Additional Authorizations, Consents, and Releases

I authorize Camp Caring staff to provide routine health care, first aid, administer prescribed medications, and seek emergency medical treatment for my child. I agree to the release of records for insurance purposes and allow necessary transportation for medical care.

I authorize the Camp Caring nurse to administer medications prescribed by our physician and release Camp Caring and its staff from liability for any effects of the administered medication.

I grant West Virginia Caring permission to take and use my photograph, image, recording, or video for promotional purposes, including publications, newsletters, and the website.

I grant West Virginia Caring permission to take and use my child’s photograph, image, recording, or video for promotional purposes during Camp Caring.

I give permission for my child to attend Camp Caring, understanding that the goal is to support their bereavement process and expression of grief.

I release Camp Caring (a program of West Virginia Caring), its staff, volunteers, and contractors from all liability for injury or property damage that may occur during my child’s participation in camp.

Bereavement History

Why is your child attending Camp Caring? Please share briefly why you are sending your child to camp. For example, you may mention a loved one they have lost and how this loss has impacted them. Your response helps us support your child’s healing journey.

A FREE ONE-DAY BEREAVEMENT CAMP FOR CHILDREN

Camper Application

Welcome to Camp Caring!

Important Information:

Contact Us:

Camper Information

Parent/Grown Up Information

Grown Up(s) Attending Camp With Child

Health History

Allergies

Toll Free: 1-866-656-9790

CONTACT US