Camp Good Mourning Registration 2026

Camp Good Mourning Registration 2026

NOTE: If you are not the legal guardian or authorized to make decisions on behalf of the child who will be registered for camp, please have the authorized individual fill out this form since there is a consent at the bottom. Please read and complete the information below. Your child will not be able to participate without having this form completed.
Camper Registration Information
Child Name*

First NameLast Name
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Age as of June 6th
Parent/Guardian Name
Special Concerns
If your child has any special concerns or medical information that we should be aware of, please indicate:
Allergies to food or other substances:
Dietary needs:
Medical concerns:
Other concerns:
To help us continue to get the word out about the camp, please let us know how you heard about Camp Good Mourning:
Contacts

Please indicate which adult is authorized to pick up your child from Camp Good Mourning. Leaders are not permitted to release your child to anyone not on this list. We will verify this information when you drop your child off at camp. Please also list an emergency contact for your child.
Authorized to Pick Up:*
Authorized to Pick Up:
Name
Relationship
Primary Phone
Emergency Contact:
Name
Relationship
Primary Phone
Emergency Contact:*
YesNo
Grief Story
Please share with us about the loved one(s) your child has lost, your child’s relationship with them, and any other information about your child’s grief that may be helpful to us during the camp.
Person Completing This Form:
Your Name:*
Relationship to Child:*
Your Email:*
Permission is requested for the child indicated at the top of this form to participate in group activities at Camp Good Mourning, a program sponsored by Altru Health System. The day camp is designed to include movement, music, creative writing, drawing, artistic activities, and discussion of your child’s feelings and opinions. Some of what will be covered includes:
- Using creativity to help children cope with loss and grief
- Communication and expression of feelings of loss and grief
Children will have the opportunity to learn new coping skills that may help their development and adjustment during this time of grief.

Because Camp Good Mourning is based on trusting relationships, the leaders will keep the information shared by participating students confidential—except in certain situations where there is an ethical obligation to break confidentiality for the safety or wellbeing of the child.

I give my informed consent for my child to participate in Camp Good Mourning.

I give permission for my child to be photographed during the camp at appropriate times. These photos may be shared with program sponsors who may or may not use the pictures later for promotional reasons or on social media. My child's name will not be shared.

I also understand my child will be taking part in physical activities that can result in risk of physical injury to my child. I therefore release and discharge all liability for any harm or injury suffered directly or indirectly as a result of my child’s participation in Camp Good Mourning.
Your Signature*

Clear
Date*

MonthDayYear
Date
If you have questions, reach out to us ahead of time at 701-780-3642, ccaron@altru.org, or ask at registration the day of camp.
Should be Empty:

Camp Good Mourning Registration 2026

Camper Registration Information

Special Concerns

Contacts

Authorized to Pick Up:

Emergency Contact:

Grief Story