Camp STARS Application Form

Camp STARS Family Application

Please fill out this application in its entirety to register for Camp STARS.

After we receive your application, we will send a packet of information for you to complete and return. The packet will include the timeline, an overview of the weekend activities and consent forms. Your registration will not be complete and your family’s place at Camp will not be confirmed until we have received the signed consent forms. Please return the consent forms and the registration fee of $40 to:

Camp STARS
Hospice Atlanta Center
1244 Park Vista Drive NE
Atlanta, GA 30319

Questions? Please contact Deana Porter at (404) 869-3072 or via email.

Camp STARS Family Application

Your Information

Loss History

How many family members, including yourself, will be attending Camp STARS? Starting with yourself, please list all family members who will be attending Camp STARS.

FIRST ATTENDEE

Sex

Age Group/Facilitated Group (choose one)

T-shirt Size (choose one)

Any life threatening allergies (ex.: peanuts, milk , bee stings)?

SECOND ATTENDEE

Sex

Age Groups/Facilitated Groups (choose one)

T-shirt Size (choose one)

Any life threatening allergies (ex.: peanuts, milk , bee stings)?

THIRD ATTENDEE

Sex

Age Groups/Facilitated Groups (choose one)

T-shirt Size (choose one)

Any life threatening allergies (ex.: peanuts, milk , bee stings)?

FOURTH ATTENDEE

Sex

Age Groups/Facilitated Groups (choose one)

T-shirt Size (choose one)

Any life threatening allergies (ex.: peanuts, milk , bee stings)?

FIFTH ATTENDEE

Sex

Age Groups/Facilitated Groups (choose one)

T-shirt Size (choose one)

Any life threatening allergies (ex.: peanuts, milk , bee stings)?

SIXTH ATTENDEE

Sex

Age Groups/Facilitated Groups (choose one)

T-shirt Size (choose one)

Any life threatening allergies (ex.: peanuts, milk , bee stings)?

SEVENTH ATTENDEE

Sex

Age Groups/Facilitated Groups (choose one)

T-shirt Size (choose one)

Any life threatening allergies (ex.: peanuts, milk , bee stings)?

EIGHTH ATTENDEE

Sex

Age Groups/Facilitated Groups (choose one)

T-shirt Size (choose one)

Any life threatening allergies (ex.: peanuts, milk , bee stings)?

NINTH ATTENDEE

Sex

Age Groups/Facilitated Groups (choose one)

T-shirt Size (choose one)

Any life threatening allergies (ex.: peanuts, milk , bee stings)?

TENTH ATTENDEE

Sex

Age Groups/Facilitated Groups (choose one)

T-shirt Size (choose one)

Any life threatening allergies (ex.: peanuts, milk , bee stings)?

Other Information