Camp Kangaroo is a free camp experience and a supportive atmosphere for

children who have experienced theloss of a loved one.

Ages 5 to 13

––––––––––––––––––––––––––––––––––––––––––––Name of child attending Camp Kangaroo

––––––––––––––––––––––––––––––––––––––––––––Name of parent or guardian

––––––––––––––––––––––––––––––––––––––––––––Telephone

––––––––––––––––––––––––––––––––––––––––––––Address

––––––––––––––––––––––––––––––––––––––––––––Email

––––––––––––––––––––––––––––––––––––––––––––Emergency Contact

––––––––––––––––––––––––––––––––––––––––––––Age Gender T-shirt size

––––––––––––––––––––––––––––––––––––––––––––Allergies

––––––––––––––––––––––––––––––––––––––––––––Food allergies

––––––––––––––––––––––––––––––––––––––––––––Medical conditions

Will your child be needing transportation? o Yes o no

––––––––––––––––––––––––––––––––––––––––––––School they attend

Registration

Seasons Hospice FoundationSummer Camp Experience

Please contact Nancy Sherman to register:One Edgewater Drive

Suite 103Norwood, MA 02062

Or call (617) 454-0200

Sponsored by

www.seasonsfoundation.org847-692-1000

®

Camp Kangaroo is funded by the Seasons Hospice Foundation a 501 (c) 3 non – profit foundation through

generous support of individuals, corporations and foundation donors. If you would like to make a donation to Seasons Hospice Foundation to support future programs like bereavement camps or just support the foundation’s

mission go to www.seasonsfoundation.org

TJX Foundation, Inc.TJX

Foundation, Inc.

Camp Kangaroo provides a camp experience and a supportive atmosphere for children who have experienced the death of a parent, sibling, grandparent or significant friend. The primary goal during this weekend will be to provide children the opportunity to meet other children who have lost a loved one and to share and normalize the feelings surrounding their experiences.

Activities throughout the weekend will focus on memorializing their loved one, self-care techniques, building relationships and having fun in spite of a difficult time.

CAMP KANGAROO ... At a Glance

Date: Saturday June 6 and Sunday June 7, 2015

Time: Saturday June 6th: 8:30 a.m. to 4:30 p.m.Sunday June 7th: 8:30 a.m. to 4:30 p.m.

Location: Mt. Ida College,777 Dedham StreetNewton, MA

StaffThe Camp will be staffed by Seasons Hospice & Palliative Care staff and volunteers, led by world renowned Dr. Russell Hilliard PhD, LCSW, MT-BC the preeminent expert, published academic and well-known author in grief and bereavement. Staff will include licensed social workers, board-certified music therapists, registered nurses, chaplains, specialized bereavement volunteers, and bereavement counselors.

Who should attend Children ages 5-13 who have experienced the loss of a loved one in the last two years. Since children experience grief in their own unique way, our campers may be at different stages of the bereavement process. Upon completion of the attached registration form, one of our staff will contact you to complete a grief inventory that will help our staff to meet each individual camper’s needs.

1. Camper’s special person(s) who died: Full Name:_________________________________ Relationship:_______________________________

2. Age of the camper at the time of the loss?_________

3. Briefly describe the relationship between the camper and the deceased._____________________ __________________________________________ __________________________________________

4. Did the camper reside with the person who died? o Yes o No

5. Does your child have difficulty with any of the following areas? Check if yes. o Sleeping:_________________________________ o Eating:__________________________________ o School:__________________________________ o Relationships:_____________________________

6. Are there any language, disability, or other needs, family customs, or cultural aspects to your child’s grieving that we should be aware of?____________ __________________________________________ __________________________________________ __________________________________________ __________________________________________

7. Please use this space to provide us with any other information about your child that will be helpful in providing a supportive camp experience._________ __________________________________________ __________________________________________ __________________________________________ __________________________________________ __________________________________________

Bereavement History Registration

Our VisionWe envision a future where more people

will celebrate life and honor its end through the guidance of hospice.