Your Information First and Last Name of Person Completing Application*
Street Address*
City*
State*
Zip*
Main Phone #*
Email*
Camper Loss History Name of Your Deceased Loved One*
Age of the Deceased*
Date of Their Death*
Cause of Their Death*
Starting with yourself, please provide information below for each person that will be attending Camp STARS. Including yourself, what is the total number of your family members attending camp?* 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25
Your First Name
Your Last Name
Age
Gender Gender Age Group/Facilitated Group (choose one) Age Child Group for Campers 0-2 Years Old Child Group for Campers 3-5 Year Old Child Group for Campers 6-8 Year Old Child Group for Campers 9-10 Year Old Child Group for Campers Middle School Age (Ages 11-12) Child Group for Campers High School Age (Ages 13-17) Young Adult Group for Campers Ages 18-25 Adult Camp Group for Loss of a Spouse/Partner Adult Camp Group for Loss of Parent Adult Camp Group for Loss of a Child (Child age was 18 and under) Adult Camp Group for Loss of a Child (Child age was 19 and over) Adult Camp Group for Loss of a Sibling Adult Camp Group for Loss of Extended Family Member (grandparent/aunt/uncle/friend, etc.) Adult Camp Group for Extreme/Traumatic Loss (suicide, homocide, car accident, etc.))
Please choose the relationship your deceased was to you (ex. My Spouse/Partner) My Spouse/Partner My Parent My Child My Brother/Sister My Grandchild My Grandparent My Brother/Sister In law My Aunt/Uncle My Nephew/Niece My Cousin My Friend
T-shirt Size (choose one) T-Shirt Size Youth Small Youth Medium Youth Large Adult Small Adult Medium Adult Large Adult XL Adult XXL Adult XXXL
Please list any allergies (food, etc.) here.
Camper #2 First Name
Last Name
Age
Gender Sex Age Groups/Facilitated Groups (choose one) Age Child Group for Campers 0-2 Years Old Child Group for Campers 3-5 Year Old Child Group for Campers 6-8 Year Old Child Group for Campers 9-10 Year Old Child Group for Campers Middle School Age (Ages 11-12) Child Group for Campers High School Age (Ages 13-17) Young Adult Group for Campers Ages 18-25 Adult Camp Group for Loss of a Spouse/Partner Adult Camp Group for Loss of Parent Adult Camp Group for Loss of a Child (Child age was 18 and under) Adult Camp Group for Loss of a Child (Child age was 19 and over) Adult Camp Group for Loss of a Sibling Adult Camp Group for Loss of Extended Family Member (grandparent/aunt/uncle/friend, etc.) Adult Camp Group for Extreme/Traumatic Loss (suicide, homocide, car accident, etc.))
Please choose the relationship your deceased was to you (ex. My Spouse/Partner) My Spouse/Partner My Parent My Child My Brother/Sister My Grandchild My Grandparent My Brother/Sister In law My Aunt/Uncle My Nephew/Niece My Cousin My Friend
T-shirt Size (choose one) T-Shirt Size Youth Small Youth Medium Youth Large Adult Small Adult Medium Adult Large Adult XL Adult XXL Adult XXXL
Please list any allergies (food, etc.) here.
Camper #3 First Name
Last Name
Age
Gender Sex Age Groups/Facilitated Groups (choose one) Age Child Group for Campers 0-2 Years Old Child Group for Campers 3-5 Year Old Child Group for Campers 6-8 Year Old Child Group for Campers 9-10 Year Old Child Group for Campers Middle School Age (Ages 11-12) Child Group for Campers High School Age (Ages 13-17) Young Adult Group for Campers Ages 18-25 Adult Camp Group for Loss of a Spouse/Partner Adult Camp Group for Loss of Parent Adult Camp Group for Loss of a Child (Child age was 18 and under) Adult Camp Group for Loss of a Child (Child age was 19 and over) Adult Camp Group for Loss of a Sibling Adult Camp Group for Loss of Extended Family Member (grandparent/aunt/uncle/friend, etc.) Adult Camp Group for Extreme/Traumatic Loss (suicide, homocide, car accident, etc.))
Please choose the relationship your deceased was to you (ex. My Spouse/Partner) My Spouse/Partner My Parent My Child My Brother/Sister My Grandchild My Grandparent My Brother/Sister In law My Aunt/Uncle My Nephew/Niece My Cousin My Friend
T-shirt Size (choose one) T-Shirt Size Youth Small Youth Medium Youth Large Adult Small Adult Medium Adult Large Adult XL Adult XXL Adult XXXL
Please list any allergies (food, etc.) here.
Camper #4 First Name
Last Name
Age
Gender Sex Age Groups/Facilitated Groups (choose one) Age Child Group for Campers 0-2 Years Old Child Group for Campers 3-5 Year Old Child Group for Campers 6-8 Year Old Child Group for Campers 9-10 Year Old Child Group for Campers Middle School Age (Ages 11-12) Child Group for Campers High School Age (Ages 13-17) Young Adult Group for Campers Ages 18-25 Adult Camp Group for Loss of a Spouse/Partner Adult Camp Group for Loss of Parent Adult Camp Group for Loss of a Child (Child age was 18 and under) Adult Camp Group for Loss of a Child (Child age was 19 and over) Adult Camp Group for Loss of a Sibling Adult Camp Group for Loss of Extended Family Member (grandparent/aunt/uncle/friend, etc.) Adult Camp Group for Extreme/Traumatic Loss (suicide, homocide, car accident, etc.))
Please choose the relationship your deceased was to you (ex. My Spouse/Partner) My Spouse/Partner My Parent My Child My Brother/Sister My Grandchild My Grandparent My Brother/Sister In law My Aunt/Uncle My Nephew/Niece My Cousin My Friend
T-shirt Size (choose one) T-Shirt Size Youth Small Youth Medium Youth Large Adult Small Adult Medium Adult Large Adult XL Adult XXL Adult XXXL
Please list any allergies (food, etc.) here.
Camper #5 First Name
Last Name
Age
Gender Sex Age Groups/Facilitated Groups (choose one) Age Child Group for Campers 0-2 Years Old Child Group for Campers 3-5 Year Old Child Group for Campers 6-8 Year Old Child Group for Campers 9-10 Year Old Child Group for Campers Middle School Age (Ages 11-12) Child Group for Campers High School Age (Ages 13-17) Young Adult Group for Campers Ages 18-25 Adult Camp Group for Loss of a Spouse/Partner Adult Camp Group for Loss of Parent Adult Camp Group for Loss of a Child (Child age was 18 and under) Adult Camp Group for Loss of a Child (Child age was 19 and over) Adult Camp Group for Loss of a Sibling Adult Camp Group for Loss of Extended Family Member (grandparent/aunt/uncle/friend, etc.) Adult Camp Group for Extreme/Traumatic Loss (suicide, homocide, car accident, etc.))
Please choose the relationship your deceased was to you (ex. My Spouse/Partner) My Spouse/Partner My Parent My Child My Brother/Sister My Grandchild My Grandparent My Brother/Sister In law My Aunt/Uncle My Nephew/Niece My Cousin My Friend
T-shirt Size (choose one) T-Shirt Size Youth Small Youth Medium Youth Large Adult Small Adult Medium Adult Large Adult XL Adult XXL Adult XXXL
Any life threatening allergies (ex.: peanuts, milk , bee stings)? Please list any allergies (food, etc.) here.
Camper #6 First Name
Last Name
Age
Gender Sex Age Groups/Facilitated Groups (choose one) Age Child Group for Campers 0-2 Years Old Child Group for Campers 3-5 Year Old Child Group for Campers 6-8 Year Old Child Group for Campers 9-10 Year Old Child Group for Campers Middle School Age (Ages 11-12) Child Group for Campers High School Age (Ages 13-17) Young Adult Group for Campers Ages 18-25 Adult Camp Group for Loss of a Spouse/Partner Adult Camp Group for Loss of Parent Adult Camp Group for Loss of a Child (Child age was 18 and under) Adult Camp Group for Loss of a Child (Child age was 19 and over) Adult Camp Group for Loss of a Sibling Adult Camp Group for Loss of Extended Family Member (grandparent/aunt/uncle/friend, etc.) Adult Camp Group for Extreme/Traumatic Loss (suicide, homocide, car accident, etc.))
Please choose the relationship your deceased was to you (ex. My Spouse/Partner) My Spouse/Partner My Parent My Child My Brother/Sister My Grandchild My Grandparent My Brother/Sister In law My Aunt/Uncle My Nephew/Niece My Cousin My Friend
T-shirt Size (choose one) T-Shirt Size Youth Small Youth Medium Youth Large Adult Small Adult Medium Adult Large Adult XL Adult XXL Adult XXXL
Please list any allergies (food, etc.) here.
Camper #7 First Name
Last Name
Age
Gender Sex Age Groups/Facilitated Groups (choose one) Age Child Group for Campers 0-2 Years Old Child Group for Campers 3-5 Year Old Child Group for Campers 6-8 Year Old Child Group for Campers 9-10 Year Old Child Group for Campers Middle School Age (Ages 11-12) Child Group for Campers High School Age (Ages 13-17) Young Adult Group for Campers Ages 18-25 Adult Camp Group for Loss of a Spouse/Partner Adult Camp Group for Loss of Parent Adult Camp Group for Loss of a Child (Child age was 18 and under) Adult Camp Group for Loss of a Child (Child age was 19 and over) Adult Camp Group for Loss of a Sibling Adult Camp Group for Loss of Extended Family Member (grandparent/aunt/uncle/friend, etc.) Adult Camp Group for Extreme/Traumatic Loss (suicide, homocide, car accident, etc.))
Please choose the relationship your deceased was to you (ex. My Spouse/Partner) My Spouse/Partner My Parent My Child My Brother/Sister My Grandchild My Grandparent My Brother/Sister In law My Aunt/Uncle My Nephew/Niece My Cousin My Friend
T-shirt Size (choose one) T-Shirt Size Youth Small Youth Medium Youth Large Adult Small Adult Medium Adult Large Adult XL Adult XXL Adult XXXL
Please list any allergies (food, etc.) here.
Camper #8 First Name
Last Name
Age
Gender Sex Age Groups/Facilitated Groups (choose one) Age Child Group for Campers 0-2 Years Old Child Group for Campers 3-5 Year Old Child Group for Campers 6-8 Year Old Child Group for Campers 9-10 Year Old Child Group for Campers Middle School Age (Ages 11-12) Child Group for Campers High School Age (Ages 13-17) Young Adult Group for Campers Ages 18-25 Adult Camp Group for Loss of a Spouse/Partner Adult Camp Group for Loss of Parent Adult Camp Group for Loss of a Child (Child age was 18 and under) Adult Camp Group for Loss of a Child (Child age was 19 and over) Adult Camp Group for Loss of a Sibling Adult Camp Group for Loss of Extended Family Member (grandparent/aunt/uncle/friend, etc.) Adult Camp Group for Extreme/Traumatic Loss (suicide, homocide, car accident, etc.))
Please choose the relationship your deceased was to you (ex. My Spouse/Partner) My Spouse/Partner My Parent My Child My Brother/Sister My Grandchild My Grandparent My Brother/Sister In law My Aunt/Uncle My Nephew/Niece My Cousin My Friend
T-shirt Size (choose one) T-Shirt Size Youth Small Youth Medium Youth Large Adult Small Adult Medium Adult Large Adult XL Adult XXL Adult XXXL
Please list any allergies (food, etc.) here.
Camper #9 First Name
Last Name
Age
Gender Sex Age Groups/Facilitated Groups (choose one) Age Child Group for Campers 0-2 Years Old Child Group for Campers 3-5 Year Old Child Group for Campers 6-8 Year Old Child Group for Campers 9-10 Year Old Child Group for Campers Middle School Age (Ages 11-12) Child Group for Campers High School Age (Ages 13-17) Young Adult Group for Campers Ages 18-25 Adult Camp Group for Loss of a Spouse/Partner Adult Camp Group for Loss of Parent Adult Camp Group for Loss of a Child (Child age was 18 and under) Adult Camp Group for Loss of a Child (Child age was 19 and over) Adult Camp Group for Loss of a Sibling Adult Camp Group for Loss of Extended Family Member (grandparent/aunt/uncle/friend, etc.) Adult Camp Group for Extreme/Traumatic Loss (suicide, homocide, car accident, etc.))
Please choose the relationship your deceased was to you (ex. My Spouse/Partner) My Spouse/Partner My Parent My Child My Brother/Sister My Grandchild My Grandparent My Brother/Sister In law My Aunt/Uncle My Nephew/Niece My Cousin My Friend
T-shirt Size (choose one) T-Shirt Size Youth Small Youth Medium Youth Large Adult Small Adult Medium Adult Large Adult XL Adult XXL Adult XXXL
Please list any allergies (food, etc.) here.
Camper #10 First Name
Last Name
Age
Gender Sex Age Groups/Facilitated Groups (choose one) Age Child Group for Campers 0-2 Years Old Child Group for Campers 3-5 Year Old Child Group for Campers 6-8 Year Old Child Group for Campers 9-10 Year Old Child Group for Campers Middle School Age (Ages 11-12) Child Group for Campers High School Age (Ages 13-17) Young Adult Group for Campers Ages 18-25 Adult Camp Group for Loss of a Spouse/Partner Adult Camp Group for Loss of Parent Adult Camp Group for Loss of a Child (Child age was 18 and under) Adult Camp Group for Loss of a Child (Child age was 19 and over) Adult Camp Group for Loss of a Sibling Adult Camp Group for Loss of Extended Family Member (grandparent/aunt/uncle/friend, etc.) Adult Camp Group for Extreme/Traumatic Loss (suicide, homocide, car accident, etc.))
Please choose the relationship your deceased was to you (ex. My Spouse/Partner) My Spouse/Partner My Parent My Child My Brother/Sister My Grandchild My Grandparent My Brother/Sister In law My Aunt/Uncle My Nephew/Niece My Cousin My Friend
T-shirt Size (choose one) T-Shirt Size Youth Small Youth Medium Youth Large Adult Small Adult Medium Adult Large Adult XL Adult XXL Adult XXXL
Please list any allergies (food, etc.) here.
Camper #11 First Name
Last Name
Age
Gender Gender Age Groups/Facilitated Groups (choose one) Age Child Group for Campers 0-2 Years Old Child Group for Campers 3-5 Year Old Child Group for Campers 6-8 Year Old Child Group for Campers 9-10 Year Old Child Group for Campers Middle School Age (Ages 11-12) Child Group for Campers High School Age (Ages 13-17) Young Adult Group for Campers Ages 18-25 Adult Camp Group for Loss of a Spouse/Partner Adult Camp Group for Loss of Parent Adult Camp Group for Loss of a Child (Child age was 18 and under) Adult Camp Group for Loss of a Child (Child age was 19 and over) Adult Camp Group for Loss of a Sibling Adult Camp Group for Loss of Extended Family Member (grandparent/aunt/uncle/friend, etc.) Adult Camp Group for Extreme/Traumatic Loss (suicide, homocide, car accident, etc.))
Please choose the relationship your deceased was to you (ex. My Spouse/Partner) My Spouse/Partner My Parent My Child My Brother/Sister My Grandchild My Grandparent My Brother/Sister In law My Aunt/Uncle My Nephew/Niece My Cousin My Friend
T-shirt Size (choose one) T-Shirt Size Youth Small Youth Medium Youth Large Adult Small Adult Medium Adult Large Adult XL Adult XXL Adult XXXL
Please list any allergies (food, etc.) here.
Camper #12 First Name
Last Name
Age
Gender Sex Age Groups/Facilitated Groups (choose one) Age Child Group for Campers 0-2 Years Old Child Group for Campers 3-5 Year Old Child Group for Campers 6-8 Year Old Child Group for Campers 9-10 Year Old Child Group for Campers Middle School Age (Ages 11-12) Child Group for Campers High School Age (Ages 13-17) Young Adult Group for Campers Ages 18-25 Adult Camp Group for Loss of a Spouse/Partner Adult Camp Group for Loss of Parent Adult Camp Group for Loss of a Child (Child age was 18 and under) Adult Camp Group for Loss of a Child (Child age was 19 and over) Adult Camp Group for Loss of a Sibling Adult Camp Group for Loss of Extended Family Member (grandparent/aunt/uncle/friend, etc.) Adult Camp Group for Extreme/Traumatic Loss (suicide, homocide, car accident, etc.))
Please choose the relationship your deceased was to you (ex. My Spouse/Partner) My Spouse/Partner My Parent My Child My Brother/Sister My Grandchild My Grandparent My Brother/Sister In law My Aunt/Uncle My Nephew/Niece My Cousin My Friend
T-shirt Size (choose one) T-Shirt Size Youth Small Youth Medium Youth Large Adult Small Adult Medium Adult Large Adult XL Adult XXL Adult XXXL
Please list any allergies (food, etc.) here.
Camper #13 First Name
Last Name
Age
Gender Sex Age Groups/Facilitated Groups (choose one) Age Child Group for Campers 0-2 Years Old Child Group for Campers 3-5 Year Old Child Group for Campers 6-8 Year Old Child Group for Campers 9-10 Year Old Child Group for Campers Middle School Age (Ages 11-12) Child Group for Campers High School Age (Ages 13-17) Young Adult Group for Campers Ages 18-25 Adult Camp Group for Loss of a Spouse/Partner Adult Camp Group for Loss of Parent Adult Camp Group for Loss of a Child (Child age was 18 and under) Adult Camp Group for Loss of a Child (Child age was 19 and over) Adult Camp Group for Loss of a Sibling Adult Camp Group for Loss of Extended Family Member (grandparent/aunt/uncle/friend, etc.) Adult Camp Group for Extreme/Traumatic Loss (suicide, homocide, car accident, etc.))
Please choose the relationship your deceased was to you (ex. My Spouse/Partner) My Spouse/Partner My Parent My Child My Brother/Sister My Grandchild My Grandparent My Brother/Sister In law My Aunt/Uncle My Nephew/Niece My Cousin My Friend
T-shirt Size (choose one) T-Shirt Size Youth Small Youth Medium Youth Large Adult Small Adult Medium Adult Large Adult XL Adult XXL Adult XXXL
Please list any allergies (food, etc.) here.
Camper #14 First Name
Last Name
Age
Gender Gender Age Groups/Facilitated Groups (choose one) Age Child Group for Campers 0-2 Years Old Child Group for Campers 3-5 Year Old Child Group for Campers 6-8 Year Old Child Group for Campers 9-10 Year Old Child Group for Campers Middle School Age (Ages 11-12) Child Group for Campers High School Age (Ages 13-17) Young Adult Group for Campers Ages 18-25 Adult Camp Group for Loss of a Spouse/Partner Adult Camp Group for Loss of Parent Adult Camp Group for Loss of a Child (Child age was 18 and under) Adult Camp Group for Loss of a Child (Child age was 19 and over) Adult Camp Group for Loss of a Sibling Adult Camp Group for Loss of Extended Family Member (grandparent/aunt/uncle/friend, etc.) Adult Camp Group for Extreme/Traumatic Loss (suicide, homocide, car accident, etc.))
Please choose the relationship your deceased was to you (ex. My Spouse/Partner) My Spouse/Partner My Parent My Child My Brother/Sister My Grandchild My Grandparent My Brother/Sister In law My Aunt/Uncle My Nephew/Niece My Cousin My Friend
T-shirt Size (choose one) T-Shirt Size Youth Small Youth Medium Youth Large Adult Small Adult Medium Adult Large Adult XL Adult XXL Adult XXXL
Please list any allergies (food, etc.) here.
Camper #15 First Name
Last Name
Age
Gender Sex Age Groups/Facilitated Groups (choose one) Age Child Group for Campers 0-2 Years Old Child Group for Campers 3-5 Year Old Child Group for Campers 6-8 Year Old Child Group for Campers 9-10 Year Old Child Group for Campers Middle School Age (Ages 11-12) Child Group for Campers High School Age (Ages 13-17) Young Adult Group for Campers Ages 18-25 Adult Camp Group for Loss of a Spouse/Partner Adult Camp Group for Loss of Parent Adult Camp Group for Loss of a Child (Child age was 18 and under) Adult Camp Group for Loss of a Child (Child age was 19 and over) Adult Camp Group for Loss of a Sibling Adult Camp Group for Loss of Extended Family Member (grandparent/aunt/uncle/friend, etc.) Adult Camp Group for Extreme/Traumatic Loss (suicide, homocide, car accident, etc.))
Please choose the relationship your deceased was to you (ex. My Spouse/Partner) My Spouse/Partner My Parent My Child My Brother/Sister My Grandchild My Grandparent My Brother/Sister In law My Aunt/Uncle My Nephew/Niece My Cousin My Friend
T-shirt Size (choose one) T-Shirt Size Youth Small Youth Medium Youth Large Adult Small Adult Medium Adult Large Adult XL Adult XXL Adult XXXL
Please list any allergies (food, etc.) here.
Camper #16 First Name
Last Name
Age
Gender Sex Age Groups/Facilitated Groups (choose one) Age Child Group for Campers 0-2 Years Old Child Group for Campers 3-5 Year Old Child Group for Campers 6-8 Year Old Child Group for Campers 9-10 Year Old Child Group for Campers Middle School Age (Ages 11-12) Child Group for Campers High School Age (Ages 13-17) Young Adult Group for Campers Ages 18-25 Adult Camp Group for Loss of a Spouse/Partner Adult Camp Group for Loss of Parent Adult Camp Group for Loss of a Child (Child age was 18 and under) Adult Camp Group for Loss of a Child (Child age was 19 and over) Adult Camp Group for Loss of a Sibling Adult Camp Group for Loss of Extended Family Member (grandparent/aunt/uncle/friend, etc.) Adult Camp Group for Extreme/Traumatic Loss (suicide, homocide, car accident, etc.))
Please choose the relationship your deceased was to you (ex. My Spouse/Partner) My Spouse/Partner My Parent My Child My Brother/Sister My Grandchild My Grandparent My Brother/Sister In law My Aunt/Uncle My Nephew/Niece My Cousin My Friend
T-shirt Size (choose one) T-Shirt Size Youth Small Youth Medium Youth Large Adult Small Adult Medium Adult Large Adult XL Adult XXL Adult XXXL
Please list any allergies (food, etc.) here.
Camper #17 First Name
Last Name
Age
Gender Sex Age Groups/Facilitated Groups (choose one) Age Child Group for Campers 0-2 Years Old Child Group for Campers 3-5 Year Old Child Group for Campers 6-8 Year Old Child Group for Campers 9-10 Year Old Child Group for Campers Middle School Age (Ages 11-12) Child Group for Campers High School Age (Ages 13-17) Young Adult Group for Campers Ages 18-25 Adult Camp Group for Loss of a Spouse/Partner Adult Camp Group for Loss of Parent Adult Camp Group for Loss of a Child (Child age was 18 and under) Adult Camp Group for Loss of a Child (Child age was 19 and over) Adult Camp Group for Loss of a Sibling Adult Camp Group for Loss of Extended Family Member (grandparent/aunt/uncle/friend, etc.) Adult Camp Group for Extreme/Traumatic Loss (suicide, homocide, car accident, etc.))
Please choose the relationship your deceased was to you (ex. My Spouse/Partner) My Spouse/Partner My Parent My Child My Brother/Sister My Grandchild My Grandparent My Brother/Sister In law My Aunt/Uncle My Nephew/Niece My Cousin My Friend
T-shirt Size (choose one) T-Shirt Size Youth Small Youth Medium Youth Large Adult Small Adult Medium Adult Large Adult XL Adult XXL Adult XXXL
Please list any allergies (food, etc.) here.
Camper #18 First Name
Last Name
Age
Gender Sex Age Groups/Facilitated Groups (choose one) Age Child Group for Campers 0-2 Years Old Child Group for Campers 3-5 Year Old Child Group for Campers 6-8 Year Old Child Group for Campers 9-10 Year Old Child Group for Campers Middle School Age (Ages 11-12) Child Group for Campers High School Age (Ages 13-17) Young Adult Group for Campers Ages 18-25 Adult Camp Group for Loss of a Spouse/Partner Adult Camp Group for Loss of Parent Adult Camp Group for Loss of a Child (Child age was 18 and under) Adult Camp Group for Loss of a Child (Child age was 19 and over) Adult Camp Group for Loss of a Sibling Adult Camp Group for Loss of Extended Family Member (grandparent/aunt/uncle/friend, etc.) Adult Camp Group for Extreme/Traumatic Loss (suicide, homocide, car accident, etc.))
Please choose the relationship your deceased was to you (ex. My Spouse/Partner) My Spouse/Partner My Parent My Child My Brother/Sister My Grandchild My Grandparent My Brother/Sister In law My Aunt/Uncle My Nephew/Niece My Cousin My Friend
T-shirt Size (choose one) T-Shirt Size Youth Small Youth Medium Youth Large Adult Small Adult Medium Adult Large Adult XL Adult XXL Adult XXXL
Please list any allergies (food, etc.) here.
Camper #19 First Name
Last Name
Age
Gender Gender Age Groups/Facilitated Groups (choose one) Age Child Group for Campers 0-2 Years Old Child Group for Campers 3-5 Year Old Child Group for Campers 6-8 Year Old Child Group for Campers 9-10 Year Old Child Group for Campers Middle School Age (Ages 11-12) Child Group for Campers High School Age (Ages 13-17) Young Adult Group for Campers Ages 18-25 Adult Camp Group for Loss of a Spouse/Partner Adult Camp Group for Loss of Parent Adult Camp Group for Loss of a Child (Child age was 18 and under) Adult Camp Group for Loss of a Child (Child age was 19 and over) Adult Camp Group for Loss of a Sibling Adult Camp Group for Loss of Extended Family Member (grandparent/aunt/uncle/friend, etc.) Adult Camp Group for Extreme/Traumatic Loss (suicide, homocide, car accident, etc.))
Please choose the relationship your deceased was to you (ex. My Spouse/Partner) My Spouse/Partner My Parent My Child My Brother/Sister My Grandchild My Grandparent My Brother/Sister In law My Aunt/Uncle My Nephew/Niece My Cousin My Friend
T-shirt Size (choose one) T-Shirt Size Youth Small Youth Medium Youth Large Adult Small Adult Medium Adult Large Adult XL Adult XXL Adult XXXL
Please list any allergies (food, etc.) here.
Camper #20 First Name
Last Name
Age
Gender Sex Age Groups/Facilitated Groups (choose one) Age Child Group for Campers 0-2 Years Old Child Group for Campers 3-5 Year Old Child Group for Campers 6-8 Year Old Child Group for Campers 9-10 Year Old Child Group for Campers Middle School Age (Ages 11-12) Child Group for Campers High School Age (Ages 13-17) Young Adult Group for Campers Ages 18-25 Adult Camp Group for Loss of a Spouse/Partner Adult Camp Group for Loss of Parent Adult Camp Group for Loss of a Child (Child age was 18 and under) Adult Camp Group for Loss of a Child (Child age was 19 and over) Adult Camp Group for Loss of a Sibling Adult Camp Group for Loss of Extended Family Member (grandparent/aunt/uncle/friend, etc.) Adult Camp Group for Extreme/Traumatic Loss (suicide, homocide, car accident, etc.))
Please choose the relationship your deceased was to you (ex. My Spouse/Partner) My Spouse/Partner My Parent My Child My Brother/Sister My Grandchild My Grandparent My Brother/Sister In law My Aunt/Uncle My Nephew/Niece My Cousin My Friend
T-shirt Size (choose one) T-Shirt Size Youth Small Youth Medium Youth Large Adult Small Adult Medium Adult Large Adult XL Adult XXL Adult XXXL
Please list any allergies (food, etc.) here.
Camper #21 First Name
Last Name
Age
Gender Sex Age Groups/Facilitated Groups (choose one) Age Child Group for Campers 0-2 Years Old Child Group for Campers 3-5 Year Old Child Group for Campers 6-8 Year Old Child Group for Campers 9-10 Year Old Child Group for Campers Middle School Age (Ages 11-12) Child Group for Campers High School Age (Ages 13-17) Young Adult Group for Campers Ages 18-25 Adult Camp Group for Loss of a Spouse/Partner Adult Camp Group for Loss of Parent Adult Camp Group for Loss of a Child (Child age was 18 and under) Adult Camp Group for Loss of a Child (Child age was 19 and over) Adult Camp Group for Loss of a Sibling Adult Camp Group for Loss of Extended Family Member (grandparent/aunt/uncle/friend, etc.) Adult Camp Group for Extreme/Traumatic Loss (suicide, homocide, car accident, etc.))
Please choose the relationship your deceased was to you (ex. My Spouse/Partner) My Spouse/Partner My Parent My Child My Brother/Sister My Grandchild My Grandparent My Brother/Sister In law My Aunt/Uncle My Nephew/Niece My Cousin My Friend
T-shirt Size (choose one) T-Shirt Size Youth Small Youth Medium Youth Large Adult Small Adult Medium Adult Large Adult XL Adult XXL Adult XXXL
Please list any allergies (food, etc.) here.
Camper #22 First Name
Last Name
Age
Gender Sex Age Groups/Facilitated Groups (choose one) Age Child Group for Campers 0-2 Years Old Child Group for Campers 3-5 Year Old Child Group for Campers 6-8 Year Old Child Group for Campers 9-10 Year Old Child Group for Campers Middle School Age (Ages 11-12) Child Group for Campers High School Age (Ages 13-17) Young Adult Group for Campers Ages 18-25 Adult Camp Group for Loss of a Spouse/Partner Adult Camp Group for Loss of Parent Adult Camp Group for Loss of a Child (Child age was 18 and under) Adult Camp Group for Loss of a Child (Child age was 19 and over) Adult Camp Group for Loss of a Sibling Adult Camp Group for Loss of Extended Family Member (grandparent/aunt/uncle/friend, etc.) Adult Camp Group for Extreme/Traumatic Loss (suicide, homocide, car accident, etc.))
Please choose the relationship your deceased was to you (ex. My Spouse/Partner) My Spouse/Partner My Parent My Child My Brother/Sister My Grandchild My Grandparent My Brother/Sister In law My Aunt/Uncle My Nephew/Niece My Cousin My Friend
T-shirt Size (choose one) T-shirt Size (choose one) T-Shirt Size Youth Small Youth Medium Youth Large Adult Small Adult Medium Adult Large Adult XL Adult XXL Adult XXXL
Please list any allergies (food, etc.) here.
Camper #23 First Name
Last Name
Age
Gender Sex Age Groups/Facilitated Groups (choose one) Age Child Group for Campers 0-2 Years Old Child Group for Campers 3-5 Year Old Child Group for Campers 6-8 Year Old Child Group for Campers 9-10 Year Old Child Group for Campers Middle School Age (Ages 11-12) Child Group for Campers High School Age (Ages 13-17) Young Adult Group for Campers Ages 18-25 Adult Camp Group for Loss of a Spouse/Partner Adult Camp Group for Loss of Parent Adult Camp Group for Loss of a Child (Child age was 18 and under) Adult Camp Group for Loss of a Child (Child age was 19 and over) Adult Camp Group for Loss of a Sibling Adult Camp Group for Loss of Extended Family Member (grandparent/aunt/uncle/friend, etc.) Adult Camp Group for Extreme/Traumatic Loss (suicide, homocide, car accident, etc.))
Please choose the relationship your deceased was to you (ex. My Spouse/Partner) My Spouse/Partner My Parent My Child My Brother/Sister My Grandchild My Grandparent My Brother/Sister In law My Aunt/Uncle My Nephew/Niece My Cousin My Friend
T-shirt Size (choose one) T-Shirt Size Youth Small Youth Medium Youth Large Adult Small Adult Medium Adult Large Adult XL Adult XXL Adult XXXL
Please list any allergies (food, etc.) here.
Camper #24 First Name
Last Name
Age
Gender Gender Age Groups/Facilitated Groups (choose one) Age Child Group for Campers 0-2 Years Old Child Group for Campers 3-5 Year Old Child Group for Campers 6-8 Year Old Child Group for Campers 9-10 Year Old Child Group for Campers Middle School Age (Ages 11-12) Child Group for Campers High School Age (Ages 13-17) Young Adult Group for Campers Ages 18-25 Adult Camp Group for Loss of a Spouse/Partner Adult Camp Group for Loss of Parent Adult Camp Group for Loss of a Child (Child age was 18 and under) Adult Camp Group for Loss of a Child (Child age was 19 and over) Adult Camp Group for Loss of a Sibling Adult Camp Group for Loss of Extended Family Member (grandparent/aunt/uncle/friend, etc.) Adult Camp Group for Extreme/Traumatic Loss (suicide, homocide, car accident, etc.))
Please choose the relationship your deceased was to you (ex. My Spouse/Partner) My Spouse/Partner My Parent My Child My Brother/Sister My Grandchild My Grandparent My Brother/Sister In law My Aunt/Uncle My Nephew/Niece My Cousin My Friend
T-shirt Size (choose one) T-shirt Size (choose one) T-Shirt Size Youth Small Youth Medium Youth Large Adult Small Adult Medium Adult Large Adult XL Adult XXL Adult XXXL
Please list any allergies (food, etc.) here.
Camper #25 First Name
Last Name
Age
Gender Sex Age Groups/Facilitated Groups (choose one) Age Child Group for Campers 0-2 Years Old Child Group for Campers 3-5 Year Old Child Group for Campers 6-8 Year Old Child Group for Campers 9-10 Year Old Child Group for Campers Middle School Age (Ages 11-12) Child Group for Campers High School Age (Ages 13-17) Young Adult Group for Campers Ages 18-25 Adult Camp Group for Loss of a Spouse/Partner Adult Camp Group for Loss of Parent Adult Camp Group for Loss of a Child (Child age was 18 and under) Adult Camp Group for Loss of a Child (Child age was 19 and over) Adult Camp Group for Loss of a Sibling Adult Camp Group for Loss of Extended Family Member (grandparent/aunt/uncle/friend, etc.) Adult Camp Group for Extreme/Traumatic Loss (suicide, homocide, car accident, etc.))
Please choose the relationship your deceased was to you (ex. My Spouse/Partner) My Spouse/Partner My Parent My Child My Brother/Sister My Grandchild My Grandparent My Brother/Sister In law My Aunt/Uncle My Nephew/Niece My Cousin My Friend
T-shirt Size (choose one) T-Shirt Size Youth Small Youth Medium Youth Large Adult Small Adult Medium Adult Large Adult XL Adult XXL Adult XXXL
Please list any allergies (food, etc.) here.
Other Information
Please note the camp’s grounds and cabins are wheelchair and walker accessible. Some cabins may be a moderate walk from the activities. Please tell us if you have any special needs that would benefit from a closer cabin or lodgings without stairs. For the safety of everyone attending Camp STARS and on the grounds of Camp Twin Lakes, family pets are NOT allowed unless it is a registered service animal. Documentation MUST be provided.
What do you find helps you/your family cope with your loss(es)? Is there anything else you would like us to know about how your family is coping with the loss?
Do you have any other questions or concerns about the weekend?
Please list any family members who have previously attended Camp STARS:
How did you hear about Camp STARS? 
