Please fill out the below form for each child attending.

Camp Dragonfly Pre-Bereavement Registration

Please fill out the form below.

To be completed by the adult:
Their Name(Required)
MM slash DD slash YYYY
Media Release - I grant permission for photographs/videos, written evaluation comments, and or interviews with me (or my child/teen) to be used for educational purposes and/or to promote future events.(Required)
By checking this box, you are electronically signing and authorizing the use of the above materials to be used in the ways listed above.
Please list any other adults that will be attending

Camper Registration

Please complete with your child
What is your name?(Required)
Please mark all that apply:(Required)

Camper Registration

To be filled out by camper's parent/legal guardian
Camper's legal name(Required)
MM slash DD slash YYYY
Mailing Address(Required)
Has the child experienced other deaths?(Required)
This field is for validation purposes and should be left unchanged.