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Guiding Star Application
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Guiding Star Application
Application for Guiding Star
First name
Last name
Deceased Loved One's Name
Date of Birth
Date of Loss
Cause of Death
Who referred you to Guiding Star?
Name
Occupation
Relationship to bereaved
Organization
Phone
Parents or Legal Guardians?
Mother's First & Last Name
Father's First & Last Name
Home Address
Home Phone
Cell Phone
Email
Full Name's and Age's of all children who will be staying with you at Camp
Child #1 Name
Age
Relationship
Miscellaneous
Children Medical Conditions: Do any of these children have a medical or other concern or condition? If YES, please explain:
Family Medical Conditions: Does anyone else in your family have a medical condition we should be aware of?
Special Interests: Does anyone in your family have any special interests, talents, or hobbies?
Expectations: What are your expectations and/or hopes for your visit to Guiding Star?
Your Story: Please tell us your loved one's story. You may give as much detail as you wish.
By checking this box, I attest that all of the above information is true and complete to the best of my knowledge.
Submit
Thanks for submitting!
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