CAMP BRAVEHEART 2015 - Northeast GeorgiaCamp Braveheart is held at Walter’s Barn which is located at 7743 Persimmon Tree Rd. Lula GA, 30554. I understand that Camp Braveheart is

Sponsored by

Camp Braveheart is a day camp for children and

youth who have experienced the death of a close

friend or family member. Founded in 1995 by the

Hospice of Northeast Georgia Medical Center, the

Braveheart Program has provided grief support to

over 1000 children via the camp experience and

school-based support groups. Camp Braveheart is carefully designed to help chil-

dren and youth learn to cope with the complicated

emotions that arise from the death of a loved one.

The most important thing that campers learn dur-

ing the week is that they are not alone — other

youth have experienced similar losses. They may

be different from the kids at church or school, but

at Camp Braveheart, they are all the same.

Camp Braveheart takes place in June and July at

Walter’s Barn in Lula, GA. This camp is pro-

vided at no cost and is open to any child in the

community who has experienced a significant

death. It is sponsored by the Hospice of North-

east Georgia Medical Center and funded by

community and private donations. For more infor-

mation on donating to Camp Braveheart, please

contact Hospice of NGMC.

CAMP BRAVEHEART 2015

A camp for children and youth who have

experienced the death of a loved one.

June 1-5 and July 13-17

Camp Activities

Journal Making

Memory Art Projects

Challenge Games

Exotic Animal Encounters

Creek Hikes/Nature Walks

Laser Tag

Water Wars

Group Discussion

Grief Education

Kickball/Softball/Football

Inflatable Waterslide or Tubing

Camp Braveheart Objectives Facilitated by a team of licensed social workers, therapists and trained

volunteers, Camp Braveheart is a structured, supportive environment

which provides campers with:

Vocabulary to talk about death, loss and intense emotions

Healthy ways to cope with those intense emotions

Opportunities to talk about and remember their loved one

A safe place to talk about changes, fears and frustrations

A chance to interact with other children/youth with similar losses

Camp Braveheart accomplishes these objectives through a combination

of play, journaling, group discussion, art therapy, challenge games and

one-on-one support.

At Camp Braveheart, we talk about sad things, but it’s not a sad

place. FUN is the underlying objective of everything we do!

Camp Braveheart is free to attend, however reg-

istration is required. Early registration is encour-

aged as space is limited to 25 campers per ses-

sion. Campers will be served on a first-come

basis with priority given to first-time campers.

Once we have received your child’s application,

we will contact you to schedule an in-person

interview with you and your child. This inter-

view is MANDATORY for all campers.

If you are unable to attend your scheduled inter-

view, you must contact our staff immediately to

re-schedule. Failure to attend or reschedule will

result in forfeiture of your child’s slot at camp.

Send your completed application(s) to:

Jill Crunkleton

Hospice of NGMC

2150 Limestone Pkwy

Suite 222

Gainesville GA 30501

Or you may fax it (include both sides) to:

Attn: Jill Crunkleton

770-219-8887

For more information, contact Jill Crunkleton, LMSW at

770-219-0274 or email [email protected]

Registering for Camp

Which session will your child attend? Rising 1st –5th Grades (June 1-5) Rising 4th—8th Grades (July 13-17)

Camper’s Name: Nickname:

Date of Birth: Age: Current Grade: Sex: M F

Parent/Guardian Name:

Address:

City, State and Zip:

Home/Cell Phone: Work Phone: Email:

Loss Information

Name of Person who Died/ Relationship to Camper:

Was the deceased served by Hospice of NGMC? Yes No Unsure Date of Death:

Circumstances of death (please be specific):

Emergency/Medical Information

Emergency Contact Name: Phone:

If your child has any allergic reactions please list them below:

Allergy: Reaction:

Child’s Physician: Phone:

Medication(s): Dose: Time:

Please list any other medical/behavioral or other information camp staff should know about your child:

Persons permitted to pick up my child from camp:

1. Name: Phone:

2. Name: Phone:

T-shirt Size : (Please Circle) Youth S Youth M Youth L

Youth XL Adult S Adult M Adult L Adult XL

Please complete a

separate application for

each child — feel free to

photocopy.

*First-time campers will

be given priority. Return

campers will be placed on

a waiting list.

Camp Braveheart 2015

Application

The Braveheart Pledge

I want to come to Camp Braveheart to have fun, to make new friends, and to learn about myself and my grief. I promise to cooperate with Camp Braveheart counselors and Big Buddies, to be considerate to other campers and to follow camp rules.

Parent/Guardian Agreement I understand that I will be contacted by hospice grief support staff within two weeks of the receipt of

this application by phone in order to confirm my child’s registration, provide staff with more in-depth

information about my child and the loss and to schedule a Camper Interview with me and my child.

I agree to attend the MANDATORY Camper Interview with my child. I understand that while camp is

provided at no cost, my child and I MUST attend this meeting in order for my child to attend camp. If

we are unable to attend our scheduled meeting, I must inform Braveheart Staff ASAP to make other

arrangements. If we fail to attend this meeting without prior notification of Braveheart Staff, my child’s

registration will be forfeited.

I understand that first-time campers are given priority. If my child has previously attended Camp Brave-

heart, he or she will be placed on “first-come, first- served” waiting list. Braveheart Staff will contact

me as soon as possible if there is an opening for my child.

Camp Braveheart is held at Walter’s Barn which is located at 7743 Persimmon Tree Rd. Lula GA,

30554. I understand that Camp Braveheart is a “day camp” which means that I or a designated party

will be responsible for dropping off and picking up my child on a daily basis. Campers should arrive no

earlier than 8:15 AM and should be picked up by 3:30 PM. Camp will conclude with a special

session for family members on Friday and parents/guardians are strongly encouraged to attend.

I understand that Camp Braveheart is facilitated by a team of licensed social workers and therapists as

well as trained volunteers. There will be a registered nurse available to render first aid. If my child

takes medication, it will need to be left with a camp counselor during check-in each morning.

Signature: ____________________________ Date: _____________________

Camper Signature/ Date

Parent/Guardian Signature/Date

Camper Printed Name