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Programs
Summer Camp
Summer Camp FAQs
Footprints
Family Retreat
Grief Coaching
Camp In A Box
About
What We Do
Our Leadership
Financial Transparency
Volunteers
Footprints Volunteer
Family Retreat Volunteer
Volunteer Opportunities
Volunteer Interest Form
News & Events
Lights Of Love
Golf Tournament
News & Media
Contact
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.
