Camp Grin Again 2019 will be held July 8-12, 2019 at Our Redeemer Lutheran Church

Parents/guardians please register your child below. Registration deadline is July 1st. Please call our office at 940-691-0982 with any questions.

Please fill out a separate registration form for each child you wish to register.

Camp Grin Again

Registration for Camp Grin Again

• Camper's Name*
  First Last
• Age*
• Gender:*
  • Male
  • Female
• Shirt Size*
  Youth SmallYouth MediumYouth LargeSmallMediumLargeXL2XL3XL
• Grade in Fall
• Has the child attended Building Bridges or Camp Grin Again*
  NoBuilding BridgesCamp Grin AgainBoth
• Address*
  Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code
• Phone*
• Alternate Phone #*
• Guardian's Email:
• Relationship of Person Who Died*
• Nature of Death*
• How Long Ago?
  Less than a month1-6 months1-3 yearsOver 3 Years
• Special issues or concerns related to the death of your child's behavior since the death:
• Anything else the facilitators should know about your child and his or her experience with loss (Death or other losses)?
• Referring Party
• In case of emergency, contact:*
• Emergency Contact Phone
  Leave blank if information is the same from above.
• Name and phone of family physician:
• Parent/Guardian Name*
  First Last
• Parent's/Guardian's Consent*
• Date*
  MM

  DD

  YYYY