FREE GRIEF SUPPORT CAMP FOR CHILDREN AND TEENS

Saturday, August 14th • 9 a.m. to 4 p.m. • Tripp Lake Camp, Poland, ME

Arts and Crafts • Music • Activities

Any child or teen grieving or anticipating the loss of a loved one can attend Camp free of charge, even if your family has not received our services.

All children and teens must be accompanied by an adult who is willing to participate.

Please fill out both registration forms below. A separate registration form must be filled out below for each child and each adult attending Camp Dragonfly.

Deadline for registration is August 3, 2021.

Call Amy Dulac, Bereavement Coordinator at 207-795-9468  if you have any questions.

Camp Dragonfly Child Registration

Please fill out the form below.
I want to go to Camp Dragonfly because: (please mark all that apply)
Bereavement History

Parent or Guardian please include as many details as possible when answering the following questions. Attach extra pages if necessary.
Has the family/child experienced multiple deaths?
Has the child received any professional support? (i.e. psychologist, psychiatrist, pastoral counselor, school counselor)
Check here to indicate that you have read and agree to Androscoggin's Camp Dragonfly COVID-19 protocols.(Required)

Camp Dragonfly Adult Registration

Please fill out the form below.
Name
Address
I want to go to Camp Dragonfly because: (please mark all that apply)
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.
Check here to indicate that you have read and agree to Androscoggin's Camp Dragonfly COVID-19 protocols.(Required)