Please complete the attached registration and permission forms. These forms must be submitted to complete your registration.

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1 Dear Parent, Thank you for registering your child for Good Grief s Grief Expressions Summer Camp! Camp will run Monday, August 20, 2018 through Friday, August 24, Hours of camp are 9:00 am 4:00 pm. Camp will be based out of Good Grief s Morristown center, located at 38 Elm Street, Morristown. Campers will be entering through the main building s front door and must be signed in and out each day by you or an authorized adult. Camp will introduce your child to various arts that allow for self-expression. Through community partnerships, your child will work with industry professionals exploring painting, drawing, writing, photography, singing, and acting. We will be in touch closer to camp with additional details and local field trips planned. Please mark your calendar for our final performance and arts exhibit, which will be held on Friday, August 24, 2018 from 3:00 to 4:00 pm. Family and friends are invited to watch our campers showcase all that they have learned and created throughout camp. Light refreshments and cake will be served as we celebrate the end of camp. We would like to offer the following suggestions: Campers are required to bring a brown bag lunch daily. Two snacks will be provided by Good Grief, however the camper is allowed to bring their own. Lunch bags should be labeled with your child s name. If possible, please refrain from sending your camper with foods that contains peanuts. Campers should eat breakfast before arriving to camp. Campers will receive a drawstring bag and water bottle to use during camp. All items brought from home should be labeled with your child s name. Campers will receive a camp T-shirt to wear each day during camp. A light jacket or sweatshirt is recommended for cool weather. Campers should bring a bottle of sunblock with them to camp as some activities will be outside, weather permitting. No cash is required for any of the activities or field trips during camp. Please do not send your child with any toys or electronic games to camp. Good Grief is not responsible for your child s cell phone or any other items brought to camp. During camp workshops, cell phones are prohibited. Please complete the attached registration and permission forms. These forms must be submitted to complete your registration. If for any reason your child is unable to attend camp, please call or Good Grief s Program Manager, Christina, at x8009 or Christina@good-grief.org. We hope your child has a fun camp experience and look forward to sharing this week!

2 REGISTRATION FORM Monday, August 20 Friday, August 24, 2018 (9:00 am 4:00 pm) CAMPER INFORMATION (USE A SEPARATE FORM FOR EACH CAMPER) Last name: First: Middle: Nickname: First Name to be Printed on nametag: Grade (As of September 2018): 1 st 2 nd 3 rd 4 th 5 th 6 th 7 th 8 th Attended Grief Expressions Summer Camp before: Y N Age (As of August 2018): DOB: Sex: Address (Street/PO Box, City, ST, ZIP): Home phone no.: Child s Cell phone no.: Known physical/medical/neurological/emotional conditions, including allergies: Please check: Current Good Grief Participant Alumni Good Grief Participant Not Enrolled at Good Grief PARENT/GUARDIAN INFORMATION Last name: First: Relationship to Camper: Address (if different than above): Home phone no.: Cell phone no.: Work phone no.: Best number to reach you at (please check one): HOME CELL WORK address: EMERGENCY CONTACTS INFORMATION (IN CASE YOU CANNOT BE REACHED) Primary Full Name: Relationship to camper: Best phone no.: Secondary Full Name: Relationship to camper: Best phone no.: GRIEF HISTORY Name of person who died: Relationship to camper: Age of person who died: of death: Cause of death: Age of camper at the time of death: Any other loss or deaths experienced by the camper: Any additional information you would like us to know: How did you hear about our camp? Please submit all registration & permission materials to: Good Grief Attn: Christina Morris 38 Elm Street Morristown, NJ Christina@good-grief.org x8009

3 Parent/Guardian Permission Statement My child has my permission to participate in all Good Grief camp activities and field trips taking place between August 20, 2018 and August 24, 2018 at Good Grief, 38 Elm Street, Morristown, NJ. If he or she appears ill, I will not send him or her to camp and will call to inform ( x8009). Pick Up List Pickup each day is at 4 pm at Good Grief, 38 Elm Street, Morristown, NJ. If you will not be picking up your child each day, please provide information for anyone who will be picking up your child. If someone arrives to pick up your child who is not on the list, your child will not be sent with them. Please instruct those picking up to have a photo ID to show staff before signing out your child at pickup. Photo Permission I give permission for Good Grief to use pictures of my child at camp for all forms of marketing including brochures, newsletters, press releases, and social media. This allows others to see the impact of camp and assists in grant and funding proposals so that we can continue to offer this program. The last name and detailed information about the identity of your child will not be included.

4 Camper Rules (Please review with your child) Campers should wear sneakers or other closed toe shoes. For safety, flip flops are strongly discouraged for camp. Campers should wear their camp T-shirt (provided on the first day of camp) each day. Campers are strongly encouraged to leave all personal electronics, games, and toys at home. Good Grief is not responsible for any lost or damaged personal property. No guests or visitors are allowed to attend during camp, except for during the final show and exhibit on the last day of camp. Good Grief is a caring environment where all feelings are welcome and heard and there is physical and emotional safety for all campers. Campers must uphold Good Grief s participant rules, which include: o No hitting or hurting others o No discriminatory language or insults o No overly violent or sexual language o No interrupting other participants o What is said at Good Grief stays at Good Grief o No judging people s emotions or stories o Respect everyone If a camper breaches any of the above rules, the camper will be reminded by camp facilitators of the inappropriateness of the situation. The camper will have the opportunity to address the issue and a chance to clarify his/her words/feelings. If the camper continues in their behavior, a Good Grief staff member will speak with the camper and, where necessary, a parent/guardian will be called. Camper Signature

5 Medical Information In the event that I cannot be reached or be present, I give Good Grief permission for my child to be taken to the hospital in case of emergency, and consent to emergency treatment until the time of my arrival at the hospital. I hereby authorize Good Grief staff to execute any and all documents including any necessary consents, agreements, and releases in my behalf which might be required by any medical facility. I understand that I will be responsible for the costs of any medical treatment provided to my child. I understand that every effort will be made to contact me in the event that such an emergency takes place, including calling all emergency contacts listed on the camp registration paperwork. Child s Primary Care Physician: Is your child taking any medication? (If yes, please specify medication, amount, and frequency taken) Child s Health Insurance Provider: Name of Policy Holder: Plan: Group #: Policy #: Health History: (please list any past medical surgeries, conditions, treatments received)