Your Information First and Last Name of Person Completing Application*
Street Address*
City*
State*
Zip*
Main Phone #*
Email*
Loss History Name of the Deceased*
Age of the Deceased*
Date of Death*
Cause of Death*
Starting with yourself, please provide information below for each person that will be attending. Including yourself, how many people will be attending?* 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*
Sex Sex* Age Group/Facilitated Group (choose one) Age* 2 and Under 3 to 5 Year Olds 6 to 8 Year Olds 9 to 10 Year Olds Middle School Age High School Age Young Adults (up to 25) with Family Member Loss Adults with Spouse/Partner Loss Adults with Parent Loss Adults with Child Loss (18 and under) Adults with Child Loss (19 and over) Adults with Sibling Loss Adults with Other Family Loss
Relationship to the Deceased Spouse/Partner Parent Child Brother/Sister Grandchild Grandparent Brother/Sister In law Aunt/Uncle Nephew/Niece Cousin 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)? If you answered Yes, please list your allergies:
SECOND ATTENDEE First Name*
Last Name*
Sex Sex* Age Groups/Facilitated Groups (choose one) Age* 2 and Under 3 to 5 Year Olds 6 to 8 Year Olds 9 to 10 Year Olds Middle School Age High School Age Young Adults (up to 25) with Family Member Loss Adults with Spouse/Partner Loss Adults with Parent Loss Adults with Child Loss (18 and under) Adults with Child Loss (19 and over) Adults with Sibling Loss Adults with Other Family Loss
Relationship to the Deceased Spouse/Partner Parent Child Brother/Sister Grandchild Grandparent Brother/Sister In law Aunt/Uncle Nephew/Niece Cousin 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)? If you answered Yes, please list your allergies:
THIRD ATTENDEE First Name*
Last Name*
Sex Sex* Age Groups/Facilitated Groups (choose one) Age* 2 and Under 3 to 5 Year Olds 6 to 8 Year Olds 9 to 10 Year Olds Middle School Age High School Age Young Adults (up to 25) with Family Member Loss Adults with Spouse/Partner Loss Adults with Parent Loss Adults with Child Loss (18 and under) Adults with Child Loss (19 and over) Adults with Sibling Loss Adults with Other Family Loss
Relationship to the Deceased Spouse/Partner Parent Child Brother/Sister Grandchild Grandparent Brother/Sister In law Aunt/Uncle Nephew/Niece Cousin 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)? If you answered Yes, please list your allergies:
FOURTH ATTENDEE First Name*
Last Name*
Sex Sex* Age Groups/Facilitated Groups (choose one) Age* 2 and Under 3 to 5 Year Olds 6 to 8 Year Olds 9 to 10 Year Olds Middle School Age High School Age Young Adults (up to 25) with Family Member Loss Adults with Spouse/Partner Loss Adults with Parent Loss Adults with Child Loss (18 and under) Adults with Child Loss (19 and over) Adults with Sibling Loss Adults with Other Family Loss
Relationship to the Deceased Spouse/Partner Parent Child Brother/Sister Grandchild Grandparent Brother/Sister In law Aunt/Uncle Nephew/Niece Cousin 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)? If you answered Yes, please list your allergies:
FIFTH ATTENDEE First Name*
Last Name*
Sex Sex* Age Groups/Facilitated Groups (choose one) Age* 2 and Under 3 to 5 Year Olds 6 to 8 Year Olds 9 to 10 Year Olds Middle School Age High School Age Young Adults (up to 25) with Family Member Loss Adults with Spouse/Partner Loss Adults with Parent Loss Adults with Child Loss (18 and under) Adults with Child Loss (19 and over) Adults with Sibling Loss Adults with Other Family Loss
Relationship to the Deceased Spouse/Partner Parent Child Brother/Sister Grandchild Grandparent Brother/Sister In law Aunt/Uncle Nephew/Niece Cousin 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)? If you answered Yes, please list your allergies:
SIXTH ATTENDEE First Name*
Last Name*
Sex Sex* Age Groups/Facilitated Groups (choose one) Age* 2 and Under 3 to 5 Year Olds 6 to 8 Year Olds 9 to 10 Year Olds Middle School Age High School Age Young Adults (up to 25) with Family Member Loss Adults with Spouse/Partner Loss Adults with Parent Loss Adults with Child Loss (18 and under) Adults with Child Loss (19 and over) Adults with Sibling Loss Adults with Other Family Loss
Relationship to the Deceased Spouse/Partner Parent Child Brother/Sister Grandchild Grandparent Brother/Sister In law Aunt/Uncle Nephew/Niece Cousin 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)? If you answered Yes, please list your allergies:
SEVENTH ATTENDEE First Name*
Last Name*
Sex Sex* Age Groups/Facilitated Groups (choose one) Age* 2 and Under 3 to 5 Year Olds 6 to 8 Year Olds 9 to 10 Year Olds Middle School Age High School Age Young Adults (up to 25) with Family Member Loss Adults with Spouse/Partner Loss Adults with Parent Loss Adults with Child Loss (18 and under) Adults with Child Loss (19 and over) Adults with Sibling Loss Adults with Other Family Loss
Relationship to the Deceased Spouse/Partner Parent Child Brother/Sister Grandchild Grandparent Brother/Sister In law Aunt/Uncle Nephew/Niece Cousin 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)? If you answered Yes, please list your allergies:
EIGHTH ATTENDEE First Name*
Last Name*
Sex Sex* Age Groups/Facilitated Groups (choose one) Age* 2 and Under 3 to 5 Year Olds 6 to 8 Year Olds 9 to 10 Year Olds Middle School Age High School Age Young Adults (up to 25) with Family Member Loss Adults with Spouse/Partner Loss Adults with Parent Loss Adults with Child Loss (18 and under) Adults with Child Loss (19 and over) Adults with Sibling Loss Adults with Other Family Loss
Relationship to the Deceased Spouse/Partner Parent Child Brother/Sister Grandchild Grandparent Brother/Sister In law Aunt/Uncle Nephew/Niece Cousin 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)? If you answered Yes, please list your allergies:
NINTH ATTENDEE First Name*
Last Name*
Sex Sex* Age Groups/Facilitated Groups (choose one) Age* 2 and Under 3 to 5 Year Olds 6 to 8 Year Olds 9 to 10 Year Olds Middle School Age High School Age Young Adults (up to 25) with Family Member Loss Adults with Spouse/Partner Loss Adults with Parent Loss Adults with Child Loss (18 and under) Adults with Child Loss (19 and over) Adults with Sibling Loss Adults with Other Family Loss
Relationship to the Deceased Spouse/Partner Parent Child Brother/Sister Grandchild Grandparent Brother/Sister In law Aunt/Uncle Nephew/Niece Cousin 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)? If you answered Yes, please list your allergies:
TENTH ATTENDEE First Name*
Last Name*
Sex Sex* Age Groups/Facilitated Groups (choose one) Age* 2 and Under 3 to 5 Year Olds 6 to 8 Year Olds 9 to 10 Year Olds Middle School Age High School Age Young Adults (up to 25) with Family Member Loss Adults with Spouse/Partner Loss Adults with Parent Loss Adults with Child Loss (18 and under) Adults with Child Loss (19 and over) Adults with Sibling Loss Adults with Other Family Loss
Relationship to the Deceased Spouse/Partner Parent Child Brother/Sister Grandchild Grandparent Brother/Sister In law Aunt/Uncle Nephew/Niece Cousin 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)? If you answered Yes, please list your allergies:
ELEVENTH ATTENDEE First Name*
Last Name*
Sex Sex* Age Groups/Facilitated Groups (choose one) Age* 2 and Under 3 to 5 Year Olds 6 to 8 Year Olds 9 to 10 Year Olds Middle School Age High School Age Young Adults (up to 25) with Family Member Loss Adults with Spouse/Partner Loss Adults with Parent Loss Adults with Child Loss (18 and under) Adults with Child Loss (19 and over) Adults with Sibling Loss Adults with Other Family Loss
Relationship to the Deceased Spouse/Partner Parent Child Brother/Sister Grandchild Grandparent Brother/Sister In law Aunt/Uncle Nephew/Niece Cousin 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)? If you answered Yes, please list your allergies:
TWELFTH ATTENDEE First Name*
Last Name*
Sex Sex* Age Groups/Facilitated Groups (choose one) Age* 2 and Under 3 to 5 Year Olds 6 to 8 Year Olds 9 to 10 Year Olds Middle School Age High School Age Young Adults (up to 25) with Family Member Loss Adults with Spouse/Partner Loss Adults with Parent Loss Adults with Child Loss (18 and under) Adults with Child Loss (19 and over) Adults with Sibling Loss Adults with Other Family Loss
Relationship to the Deceased Spouse/Partner Parent Child Brother/Sister Grandchild Grandparent Brother/Sister In law Aunt/Uncle Nephew/Niece Cousin 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
If you answered Yes, please list your allergies:
THIRTEENTH ATTENDEE First Name*
Last Name*
Sex Sex* Age Groups/Facilitated Groups (choose one) Age* 2 and Under 3 to 5 Year Olds 6 to 8 Year Olds 9 to 10 Year Olds Middle School Age High School Age Young Adults (up to 25) with Family Member Loss Adults with Spouse/Partner Loss Adults with Parent Loss Adults with Child Loss (18 and under) Adults with Child Loss (19 and over) Adults with Sibling Loss Adults with Other Family Loss
Relationship to the Deceased Spouse/Partner Parent Child Brother/Sister Grandchild Grandparent Brother/Sister In law Aunt/Uncle Nephew/Niece Cousin 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)? If you answered Yes, please list your allergies:
FOURTEENTH ATTENDEE First Name*
Last Name*
Sex Sex* Age Groups/Facilitated Groups (choose one) Age* 2 and Under 3 to 5 Year Olds 6 to 8 Year Olds 9 to 10 Year Olds Middle School Age High School Age Young Adults (up to 25) with Family Member Loss Adults with Spouse/Partner Loss Adults with Parent Loss Adults with Child Loss (18 and under) Adults with Child Loss (19 and over) Adults with Sibling Loss Adults with Other Family Loss
Relationship to the Deceased Spouse/Partner Parent Child Brother/Sister Grandchild Grandparent Brother/Sister In law Aunt/Uncle Nephew/Niece Cousin 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)? If you answered Yes, please list your allergies:
FIFTEENTH ATTENDEE First Name*
Last Name*
Sex Sex* Age Groups/Facilitated Groups (choose one) Age* 2 and Under 3 to 5 Year Olds 6 to 8 Year Olds 9 to 10 Year Olds Middle School Age High School Age Young Adults (up to 25) with Family Member Loss Adults with Spouse/Partner Loss Adults with Parent Loss Adults with Child Loss (18 and under) Adults with Child Loss (19 and over) Adults with Sibling Loss Adults with Other Family Loss
Relationship to the Deceased Spouse/Partner Parent Child Brother/Sister Grandchild Grandparent Brother/Sister In law Aunt/Uncle Nephew/Niece Cousin 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)? If you answered Yes, please list your allergies:
SIXTEENTH ATTENDEE First Name*
Last Name*
Sex Sex* Age Groups/Facilitated Groups (choose one) Age* 2 and Under 3 to 5 Year Olds 6 to 8 Year Olds 9 to 10 Year Olds Middle School Age High School Age Young Adults (up to 25) with Family Member Loss Adults with Spouse/Partner Loss Adults with Parent Loss Adults with Child Loss (18 and under) Adults with Child Loss (19 and over) Adults with Sibling Loss Adults with Other Family Loss
Relationship to the Deceased Spouse/Partner Parent Child Brother/Sister Grandchild Grandparent Brother/Sister In law Aunt/Uncle Nephew/Niece Cousin 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)? If you answered Yes, please list your allergies:
SEVENTEENTH ATTENDEE First Name*
Last Name*
Sex Sex* Age Groups/Facilitated Groups (choose one) Age* 2 and Under 3 to 5 Year Olds 6 to 8 Year Olds 9 to 10 Year Olds Middle School Age High School Age Young Adults (up to 25) with Family Member Loss Adults with Spouse/Partner Loss Adults with Parent Loss Adults with Child Loss (18 and under) Adults with Child Loss (19 and over) Adults with Sibling Loss Adults with Other Family Loss
Relationship to the Deceased Spouse/Partner Parent Child Brother/Sister Grandchild Grandparent Brother/Sister In law Aunt/Uncle Nephew/Niece Cousin 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)? If you answered Yes, please list your allergies:
EIGHTEENTH ATTENDEE First Name*
Last Name*
Sex Sex* Age Groups/Facilitated Groups (choose one) Age* 2 and Under 3 to 5 Year Olds 6 to 8 Year Olds 9 to 10 Year Olds Middle School Age High School Age Young Adults (up to 25) with Family Member Loss Adults with Spouse/Partner Loss Adults with Parent Loss Adults with Child Loss (18 and under) Adults with Child Loss (19 and over) Adults with Sibling Loss Adults with Other Family Loss
Relationship to the Deceased Spouse/Partner Parent Child Brother/Sister Grandchild Grandparent Brother/Sister In law Aunt/Uncle Nephew/Niece Cousin 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)? If you answered Yes, please list your allergies:
NINETEENTH ATTENDEE First Name*
Last Name*
Sex Sex* Age Groups/Facilitated Groups (choose one) Age* 2 and Under 3 to 5 Year Olds 6 to 8 Year Olds 9 to 10 Year Olds Middle School Age High School Age Young Adults (up to 25) with Family Member Loss Adults with Spouse/Partner Loss Adults with Parent Loss Adults with Child Loss (18 and under) Adults with Child Loss (19 and over) Adults with Sibling Loss Adults with Other Family Loss
Relationship to the Deceased Spouse/Partner Parent Child Brother/Sister Grandchild Grandparent Brother/Sister In law Aunt/Uncle Nephew/Niece Cousin 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)? If you answered Yes, please list your allergies:
TWENTIETH ATTENDEE First Name*
Last Name*
Sex Sex* Age Groups/Facilitated Groups (choose one) Age* 2 and Under 3 to 5 Year Olds 6 to 8 Year Olds 9 to 10 Year Olds Middle School Age High School Age Young Adults (up to 25) with Family Member Loss Adults with Spouse/Partner Loss Adults with Parent Loss Adults with Child Loss (18 and under) Adults with Child Loss (19 and over) Adults with Sibling Loss Adults with Other Family Loss
Relationship to the Deceased Spouse/Partner Parent Child Brother/Sister Grandchild Grandparent Brother/Sister In law Aunt/Uncle Nephew/Niece Cousin 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)? If you answered Yes, please list your allergies:
TWENTY FIRST ATTENDEE First Name*
Last Name*
Sex Sex* Age Groups/Facilitated Groups (choose one) Age* 2 and Under 3 to 5 Year Olds 6 to 8 Year Olds 9 to 10 Year Olds Middle School Age High School Age Young Adults (up to 25) with Family Member Loss Adults with Spouse/Partner Loss Adults with Parent Loss Adults with Child Loss (18 and under) Adults with Child Loss (19 and over) Adults with Sibling Loss Adults with Other Family Loss
Relationship to the Deceased Spouse/Partner Parent Child Brother/Sister Grandchild Grandparent Brother/Sister In law Aunt/Uncle Nephew/Niece Cousin 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)? If you answered Yes, please list your allergies:
TWENTY SECOND ATTENDEE First Name*
Last Name*
Sex Sex* Age Groups/Facilitated Groups (choose one) Age* 2 and Under 3 to 5 Year Olds 6 to 8 Year Olds 9 to 10 Year Olds Middle School Age High School Age Young Adults (up to 25) with Family Member Loss Adults with Spouse/Partner Loss Adults with Parent Loss Adults with Child Loss (18 and under) Adults with Child Loss (19 and over) Adults with Sibling Loss Adults with Other Family Loss
Relationship to the Deceased Spouse/Partner Parent Child Brother/Sister Grandchild Grandparent Brother/Sister In law Aunt/Uncle Nephew/Niece Cousin 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)? If you answered Yes, please list your allergies:
TWENTY THIRD ATTENDEE First Name*
Last Name*
Sex Sex* Age Groups/Facilitated Groups (choose one) Age* 2 and Under 3 to 5 Year Olds 6 to 8 Year Olds 9 to 10 Year Olds Middle School Age High School Age Young Adults (up to 25) with Family Member Loss Adults with Spouse/Partner Loss Adults with Parent Loss Adults with Child Loss (18 and under) Adults with Child Loss (19 and over) Adults with Sibling Loss Adults with Other Family Loss
Relationship to the Deceased Spouse/Partner Parent Child Brother/Sister Grandchild Grandparent Brother/Sister In law Aunt/Uncle Nephew/Niece Cousin 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)? If you answered Yes, please list your allergies:
TWENTY FOURTH ATTENDEE First Name*
Last Name*
Sex Sex* Age Groups/Facilitated Groups (choose one) Age* 2 and Under 3 to 5 Year Olds 6 to 8 Year Olds 9 to 10 Year Olds Middle School Age High School Age Young Adults (up to 25) with Family Member Loss Adults with Spouse/Partner Loss Adults with Parent Loss Adults with Child Loss (18 and under) Adults with Child Loss (19 and over) Adults with Sibling Loss Adults with Other Family Loss
Relationship to the Deceased Spouse/Partner Parent Child Brother/Sister Grandchild Grandparent Brother/Sister In law Aunt/Uncle Nephew/Niece Cousin 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)? If you answered Yes, please list your allergies:
TWENTY FIFTH ATTENDEE First Name*
Last Name*
Sex Sex* Age Groups/Facilitated Groups (choose one) Age* 2 and Under 3 to 5 Year Olds 6 to 8 Year Olds 9 to 10 Year Olds Middle School Age High School Age Young Adults (up to 25) with Family Member Loss Adults with Spouse/Partner Loss Adults with Parent Loss Adults with Child Loss (18 and under) Adults with Child Loss (19 and over) Adults with Sibling Loss Adults with Other Family Loss
Relationship to the Deceased Spouse/Partner Parent Child Brother/Sister Grandchild Grandparent Brother/Sister In law Aunt/Uncle Nephew/Niece Cousin 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)? If you answered Yes, please list your allergies:
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.
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?*
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