Camper Application – Step 4 C1 Camper Application - Step 4.1 Child Application Camp Dates for ChildYou can select to apply for programs and camp dates for each child depending on their age.Are you applying for Camp Magic (next available) Family Day Camp Healthy Grieving virtual camp Let's talk Suicide virtual camp Graduation Camp HiddenCamp Magic Dates applying for*Family Day Camp Dates applying for*Family Day Camp Hunter-NE 12th August 2023Family Day Camp ACT 24th September 2023Family Day Camp Sydney 14th October 2023Family Day Camp Victoria 25th November 2023Family Day Camp Let's Talk Suicide Sydney 25th June 2023Healthy Grieving Virtual CampHGP.P1 7-9 years 24th and 25th June 2023HGP.P3 14-17 years 8th and 9th July 2023HGP.P2 10-13 years 5th and 6th August 2023HGP.P3 14-17 years 9th and 10th September 2023HGP.P2 10-13 years 21st and 22nd October 2023HGP.P1 7-9 years 11th and 12th November 2023HGP.P3 14-17 years 2nd and 3rd December 2023Let's Talk Suicide Virtual ProgramLTS.P3 Program 3 14-17yrs 21st and 25th June 2023LTS.P1 Program 1 7-9 yrs 16th and 20th August 2023LTS.P2 Program 2 10-13yrs 13th and 17th September 2023LTS.P3 Program 3 14-17yrs 1st and 5th November 2023LTS.P2 Program 2 10-13yrs 22nd and 26th November 2023LTS.P1 Program 1 7-9 yrs 22nd and 26th November 2023Camper InformationName* First Name Last Name Preferred Name Gender*Please select oneFemaleMaleOtherD.O.B*DD12345678910111213141516171819202122232425262728293031MM123456789101112YYYY202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920HiddenAge* Childs T-Shirt Size* School* School Grade* Main Language Spoken At Home* Face to Face camp questionsDoes this child have any allergies?*Please select oneYesNoPlease list child's allergiesDoes this child have any dietary requirements?*Please select oneYesNoPlease list child's dietary requirementsCamp Magic Related QuestionsDoes this child have any sleeping problems: i.e. Sleepwalking, Bedwetting, Nightmares, etc..*Please select oneYesNoPlease specify what and best control measureDoes this child have any medical, disability or learning difficulties (Check all that apply)* ADD ADHD Anaphalaxis Anxiety ASD Asthma Bipolar Conduct Disorder Cystic Fibrosis Depression Diabetes Epilepsy Learning Disorder ODD Other N/A Please provide further information regarding any medical, disability or learning difficulties*Is the child known to any child protection agencies*Please select oneYesNoPlease list with whom they are registered with, along with a brief descriptionWhat do you want this child to learn from camp*What type of mentor will best match this child*InterestsWhat are this child's interest/hobbies*Give a brief description of this child's personality*Bereavement detailsDeceased relationship to camper*Please select oneMotherFatherBrotherSisterGrandmotherGrandfatherStepmotherStepfatherAdoptive MotherAdoptive FatherFoster MotherFoster FatherAuntyUncleOtherOther Relation Age of your child at the time of death* Did the child witness the death?*Please select oneYesNoDid the child attend the funeral/memorial service?*Please select oneYesNoWhat were your child’s reactions to/comments about the service?Describe in detail the child’s relationship with the deceased and how his or her life has been affected by the death*Counselling and Support GroupsHas the child been in any support groups or sought counselling?*Please select oneYesNoHas the child been in any support groups or sought counselling? (yes, please elaborate)Has the child ever received mental health counselling?*Please select oneYesNoHas the child ever received mental health counselling? (If yes, please elaborate)Name of Mental Health Professional Contact Number of Mental Health Professional Mental Health Professional's Contact Email Address* Consent to contact child’s mental health professional?*YesNoFrom time to time our Head Psychologist may need to consult with your child's Psychologist / CounsellorChild's Experience and BehavioursHas the child exhibited any of the following behaviours since the death? (Check all that apply)* Attempted suicide Bed wetting Behavioral problems at home Behavioral problems at school Changes in grades Depression Destruction of property Discussed suicide Drug/alcohol use Exhibiting behaviors younger than their age Getting into fights Harmed others Harmed self Increased physical illness Intense anger Intense clinging or longing Intense guilt Involvement with the police/law enforcement Isolates self or spends excessive time alone Lying Mental health concerns Nightmares Ongoing sleep problems Run away from home Stealing Unusual fears Unusual/inappropriate sexual behaviour None of the above If yes to any of the above, please elaboratePlease explain how the child expresses grief and what triggers emotions such as: Anger, Sadness, Depression, etc.*Has the child experienced any of the following? (Check all that apply)* Change in friendship groups Change of school Divorce of parents/guardians Friends or family have become distant Major illness Major illness of family member New house/Moving Other deaths Separation of parents/guardians None of the above If yes to any of the above, please elaborateHas the child said or done anything recently that has concerned you?*Please select oneYesNoWhat behaviour has you concerned?How does your child connect with and relate to peers?*Have you and the child talked about him/her coming to Camp?*Please select oneYesNoIs there anything else we should know about the child?*Click here to apply for another Camper Apply for another child to attend camp