Good Grief Camp Online Registration

Good Grief Camp Online Registration
Saturday, October 11, 2025

Child's First Name

Child's Last Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Age

Grade/School

Select T-Shirt Size

Parent/Guardian's First Name

Parent/Guardian's Last Name

Relationship to Child

Please note, a parent/guardian is required to attend with the child.

Primary Phone

Alternative Phone

How did you hear about us?

We’ll begin camp with a short opening ceremony and invite you to bring a photo of your loved one. Each picture will be placed on a special banner for the ceremony, and you’re welcome to take it back with you after camp.

So we can help your child as much as possible, we would like to know:

How long has it been since your loved one's passing?

What was their relationship to the child?

Does the child have any medical conditions we should be aware of?

Does the child have any food or other allergies we should be aware of?

I grant permission to Kaweah Health Hospice for the use of the photograph(s) or electronic media images from The Good Grief Camp in any presentation of any and all kind whatsoever. I understand that I can revoke this authorization at any time by notifying Kaweah Health Hospice in writing. The revocation will not affect any actions taken before the receipt of this written notification. Images will be stored in a secure location and only authorized staff will have access to them. They will be kept as long as they are relevant and after that time destroyed or archived.

I grant permission for the child listed in this registration form to attend The Good Grief Camp sponsored by Kaweah Health Hospice. I understand that all reasonable safety precautions will be taken at all times by Kaweah Health Hospice. I authorize any treatment by an accredited hospital and/or physician deemed necessary for the subject of the release in case of an emergency. I understand the possibility of unforeseen hazards and know the inherent possibility of risk. I agree not to hold Kaweah Health Care District liable for damages, losses, diseases, or injuries incurred by the subject of this form.

Electronic Signature Acknowledgement

By typing my full legal name below, I understand and agree that this will serve as my electronic signature and has the same effect as a handwritten signature.

Date

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