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Programs
Summer Camp
Summer Camp FAQs
Footprints
Family Retreat
Grief Coaching
Camp In A Box
About Us
What We Do
Our Leadership
Financial Transparency
Volunteers
Footprints Volunteer
Family Retreat Volunteer
Volunteer Opportunities
Volunteer Interest Form
News and Events
Lights Of Love 2025
Golf Tournament
News & Media
Contact Us
Ask For Prayer
Facebook
X
YouTube
Instagram
Camp Agape Camper Pre-Application
Parent/Guardian Information
Parent or Guardian
(Required)
Your First Name
Your Last Name
Relationship to the Camper:
(Required)
Parent
Grandparent
Legal Guardian
Other
If Other, Please Specify:
(Required)
Your Phone Number
(Required)
Your Email
(Required)
Camper Information
Camper's Name
(Required)
Camper First Name
Camper Last Name
Campers Date of Birth
(Required)
MM slash DD slash YYYY
Camper’s Gender:
(Required)
Male
Female
What was your child’s relationship to the loved one who passed away?
(Required)
Parent
Sibling
Grandparent
Other
If Other, Please Specify:
(Required)
Did the Camper Live with Their Loved One Who Passed Away?
(Required)
Yes
No
If “No,” please answer the following:
(Required)
Daily
Several times per week
Once a week
Less than once a week
Name of the Loved One Who Passed Away:
(Required)
Cause of Death:
(Required)
Bad Health
Suicide
Murder/Homicide
Car Accident
Vehicular Accident (Non-Car)
Cancer
General Accident
Military (Combat or Service-Related)
Drowning
Drug Overdose
Natural Disaster
Medical Complications
Fire
Heart Attack
Stroke
Chronic Illness
Workplace Accident
Infectious Disease
Domestic Violence
Gun Violence (Non-Domestic)
Other
Other
(Required)
CAPTCHA
Thank you for your interest in Camp Agape. This short form helps us learn more about your child and ensure our program is a good fit. Please complete all fields.
