Creative HeArts Camp Camper Application 2022

Thank you for your interest in Alive's Creative HeArts Camp. This week-long creative arts day camp provides campers opportunities to explore their creativity through a variety of creative arts and community-building activities with peers who have experienced the death of a special person. Campers will sample a variety of artistic disciplines including visual arts, movement, poetry/writing, and theater arts. In addition to exploring the expressive arts, campers will learn mindfulness techniques and coping skills for challenging times.

Please review the following information prior to completing the application:

1. Creative HeArts camp is for children and teens ages 12-17 who have experienced the death of someone significant. Applications for campers aged 10-11 may be submitted for special consideration.

2. Camp is held July 11th - 15th, 2022 at Alive's Grief Center in Midtown Nashville. Camp activities run from 9:00 am - 4:00 pm with an optional early and late dropoff (8:00 am/5:30 pm) for an additional one-time fee. Campers must attend all days of camp.

3. Cost is $150 for up to two campers from the same household. Additional campers at $50. A 50% deposit is due mid-June to hold your camper's spot at camp.

4. Scholarships: Thanks to the generosity of our donors, scholarships are available based on need and can be discussed during your camper orientation session. If you are interested in sponsoring a needs-based camper, please indicate so on your registration.

5. All camper applications will be reviewed by Alive's Grief Center staff. Guardians may be contacted to schedule a 15-30 minute virtual orientation session with our Camp Intake Counselor. This would provide a one-on-one opportunity for us to discuss your family's loss in more detail, learn more about your camper's needs and cover any questions about camp that you might have. Applications are considered on a first-come-first-serve basis, and space is extremely limited to 15 spots, so register early!

Please contact us if you have any questions: 615-963-4732 or email: griefsupport@alivehospice.org

About You

Your contact information is used for camp communications and occasional grief support mailings.

Your name *

Your relationship to the camper you are registering *

Your email address *

House Number and Street Name *

City *

State *

Zip Code *

Your Phone number *

Guardian Status *

Attach parenting plan, if applicable

How did you hear about camp? *

Thanks to our generous donors, there are a limited number of needs-based scholarships available. Would you like your camper to be considered for a scholarship? *

Are you interested in donating and sponsoring a camper-in-need to attend camp? *

Demographic Information

The majority of camp funds have been generously donated through grants, foundations, individual, and corporate donations. To ensure future funding for the program, camper demographic information is required and will be used ONLY for the purpose outlined by grant requirements and for use when writing other grants to seek funding for the program.

Approximate Gross Household Income *

# of people living in household *

Race/Ethnicity *

If other, please describe:

Is either guardian an active, reserve, national guard military member or military veteran? *

Yes

No

Was the deceased an active, reserve, national guard military member or military veteran? *

Yes

No

Married	Widowed
Divorced, Joint Custody	Divorced, Sole Custody
Legal Temporary Guardian	Other