Camp Good Grief is a free day camp for children ages 5 to 17 who have experienced the loss of a parent, sibling, grandparent, aunt, uncle, or anyone who has been important in their life.

Losing a loved one is difficult at any age. But it is especially hard on a child. Foundedin 2005, Camp Good Grief helps children who are struggling with the difficult emotions of a loss. At camp, children are able to express themselves and meet others their age dealing with similar situations.

Camp includes confidence building programs and age based support that helps kids to break the isolation that grief often brings. At camp, children find a place where they have a voice and can start to heal in a safe and fun environ-ment.

CAMP DIRECTORPam Sengstock920-321-2004

920-321-2005 faxPamela.Sengstock@Compassus.com

MAIL REGISTRATION FORM Camp Good Grief

Compassus: 3237 Riverside Dr.Green Bay WI 54301

If you know someone who would benefit from Camp Good Grief’s services or if you or your company would like to learn more about volunteering or

making a donation, please contact us today.

CONTACT US

HELPING CHILDREN TO HEAL

Youth: YM (8-10) YL (10-12) YXL (14-16)Adults: S, M, L, XL, 2XL, 3XL

as of 9/1/16

Parent/Guardian E-mail:

Name of Deceased:

Relation to Camper:Cause of Death: Date of Death:

Was the death expected: n Yes n No

Parent/Guardian:

Camper’s Last Name:

First Name: Middle Name:

Home Address:

Is this your first time attending camp? n Yes n No

Home Phone: Cell Phone: Work Phone:

Please attach a separate sheet of paper to describe anychanges in your child’s thoughts, feelings, or behaviors

that you have noticed since the death.

REGISTRATION FORM

CAMPER INFORMATION

CONTACT INFORMATION

ATTENDING CAMP IN MEMORY OF

T-SHIRT SIZING

Name of School: Current Grade: Age:

Date of Birth: Sex: n Male n Female

Today’s Date:

FAX REGISTRATION FORM920-321-2005

If faxing, please call to confirm registration form has been received

Registration Deadline: Tuesday, September 5, 2017

Please send a picture of child in with registration form for counselor reference and bio page created for each child

Registration Deadline: Tuesday, September 5, 2017

Parents and Guardians:Please join us from 2:00PM - 3:00PM

as we address your questions about support for your children at this time.

STAFFCamp Good Grief’s volunteer staff, which isled by a team of grief and loss professionals,is carefully screened and receives specialized

training on children’s grief issues. Group leaders encourage children to process their grief in a healthy and constructive way.

CAMP SUMMARYDATE AND TIME

Camp will be held on Saturday, September 16, 2017Check-in 8:30 am - 9:00 am

Camp 8:00 am - 4:00 pm

LOCATIONWinni-Y-Co

4528 Wagon Trail Rd.Oshkosh WI 54904

“ I believe that thesechildren will carry thelove and concern thatwas shown to them forthe rest of their lives.”

-Grandmother of Camper

Parent/Guardian Signature Date

Parent/Guardian Signature Date

Name:

Relationship to Camper:

Phone Number:

IN CASE OF EMERGENCY

CONSENTBy signing below, I consent to the following:

I give Compassus, Hospice Angels Foundation and Camp Good Grief staff permission to photograph, video

and/or interview my child and to use these images, recordings, and/or quotes in staff training and in the

promotion of camp in the community via brochures, ads, newspaper articles, and other forms of publication.

Please list any allergies and/or dietary restrictions thatyour child may have:

In the event of an emergency or sickness, I authorize thecamp nurse to render necessary first aid. In the event thatappropriate treatment cannot be provided at the campsite,

I consent for my child to be taken to the EmergencyDepartment where the physician will exercise his or her

best judgment as to the diagnosis or treatment and hospitalservice that may be rendered. I understand that, should theneed for medical care arise, I will be financially responsible

for all costs incurred in rendering and providing medicalattention to my child and neither Compassus,

Hospice Angels Foundation nor Camp Good Grief isobligated to provide insurance or assume financial

responsibility for medical assistance provided.

REGISTRATION DEADLINE: Tuesday, September 5, 2017

MEALSBreakfast, lunch and snacks

available to all campers