When

Thursday, July 12, 2018 at 8:30 AM CDT
-to-
Friday, July 13, 2018 at 3:30 PM CDT

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Where

First United Methodist Church

301 Church Street
Sulphur Springs, TX 75842

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Contact

Mark Davenport
Cypress Basin Hospice
903-577-1510
m.davenport@cbhospice.org

Camp Brave Heart 2018- Sulphur Springs

Join Cypress Basin Hospice for Camp Brave Heart 2018 presented by Everett Toyota of Mt. Pleasant. A free children's grief camp for children ages 6-12 who have experienced loss through death.

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Camper Information

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    Gender:

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Parent/Guardian Information

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Additional Information

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  • Photo Consent: Cypress Basin Hospice would like to use photos of our campers and volunteers for future publicity of Camp Brave Heart.

Bereavement History

  • Did the child live with the deceased?

  • Was the child present at the time of death?

  • Does the child know the facts about the cause of death?

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  • Please select if your child has exhibited any of the following since the death of the loved one:

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  • Child's Health History: Does your child have any of the following:

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  • Authorization for Emergency Medical Treatment: Should a medical emergency arise during my child's participation in Camp Brave Heart activity, I consent to: (Please check all that you consent to. Selecting these serve as your consent for treatment.)

  • I, as parent/guardian and on behalf of my child listed above, release and discharge Cypress Basin Hospice and camp facility, their agents, employees, directors, volunteers, and officers from any legal responsibility and/or liability for any personal injuries or illnesses, sustained by my child, either physical or emotional, or injury to property, real or personal, whether injury is due to negligence or any other cause, ,which may occur while my child attends Camp Brave heart, or which may arise in the future and/or may be related to my child's attendance at Camp Brave Heart.


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