Volunteer Information

Camper Application Package

Dear Parent/Caregiver,

Thank you for your interest in Camp Keaton Hamilton. Please complete the application package for our annual camp taking place from Friday, June 7th to Sunday, June 9th, 2024.

We are very excited to be able to offer this camp opportunity free-of-charge to children and teenagers in your family who meet the following criteria.

are between the ages of 7 and 17
have not previously attended Camp Keaton
do not require one-to-one support
have experienced the death of someone close to them and are at least six months into their grief process
campers must live in the catchment boundaries- Hamilton and surrounding area, Oakville/Mississauga, Fort Erie/Niagara Falls, Guelph, Brantford

The deadline for applications was Friday, April 5th, 2024 - due to available space you may still apply for a limited time. Please note that only COMPLETED forms will be considered and one application must be filled out for each camper. Acceptance into the Camp Keaton program will be conducted on a first-come, first-serve basis, and there are a limited number of spaces for participants. Families will be called and an interview will be held to determine camper readiness.

The application is divided up into 5 sections, each must be fully completed in order to apply.

Camp Keaton Consent Waiver
Application and Medical information
Bereavement History Form
Custody of Child Form
Media and Photo Posting Policy

Please note that all campers and caregivers are required to attend a special Camp Keaton Meet & Greet evening event, to be held in May, date to be announced. This event will provide an opportunity for campers, families, and volunteers to meet each other and receive additional important information about Camp Keaton

If you have any questions or require any additional information, please do not hesitate to contact Cara Grosset, Director of Camp Keaton 905-387-2448, ext. 2206.

We hope to see you at Camp!

* Required Fields

Bereavement History Form

Bereavement History

Please include as many details as possible when answering the following questions. We understand that answering some of these questions might be difficult; however, we want to be able to provide the best possible care for your child/teen.

Child/teen’s Name:

1. Full name of deceased

Relationship to child/teen:

2. Birth date of deceased

Date of death:

3. Age of deceased at time of death

Age of child/teen at time of death:

4. Was the deceased a resident at the Dr. Bob Kemp Hospice at the time of death?

Yes

5. Was the death anticipated or sudden?

6. What was the deceased’s cause of death?

7. Please check if either of the following statements are true:

Child/teen has not been told the facts about the deceased’s cause of death. (Please Note: All campers must know the facts of the deceased death to attend camp).

Child/teen does not understand the facts about the deceased’s cause of death.

If either is checked, please explain:

8. Is this your child/teen’s first experience with death?

Yes

If no, please comment on other deaths your child/teen has experienced

9. Where did this person die?

10. Was the child/teen present at the time of death?

Yes

11. Did the child/teen see the deceased after the death?

Yes

12. Was there a funeral or memorial service?

Yes

If yes, did your child/teen attend and what were your child/teen’s comments/reactions to the service?

13. Did the child/teen live with the deceased?

Yes

14. How would you describe your child/teen’s relationship with the deceased?

15. How would you describe your family’s communication style regarding the death?

16. Does your child/teen speak openly about the person who died?

17. Please explain how your child/teen indicates that he/she is grieving?

Reaction to the Loss:

Please place a check mark next to any of the following your child/teen has exhibited since the death of the loved one:

Other Important Information:

1. Has your child/teen received any professional support (i.e. school counsellor, mental health therapist, peer support group, psychiatrist, pastoral support)?

If yes, is support currently provided? Please give approximate dates of when support started/ended.

2. Have there been any other changes/stresses in your child/teen’s life (i.e. illness, relocation, divorce, remarriage, finances, other losses)? Please explain:

3. Has your child/teen ever experienced abuse of any kind?

If yes, please explain:

Please note that staff uses their utmost discretion in determining when contact by e-mail is appropriate and do not use e-mail to communicate regarding medical, counselling or family care issues.

Custody of Child Form

Full Name of Camper

Birth Date of Camper: (mm/dd/yyyy)

I am the parent or legal guardian of the camper identified above. I hereby authorize and direct Camp Keaton, its staff, and/or its volunteers to release my child to the following person(s) during or at the end of Camp Keaton for purposes of transporting or otherwise assuming custody of my child:

Full Name of Parent or Legal Guardian of the Camper

Address:

City:

Postal Code:

Phone Number:

Cell Phone Number:

If it is necessary for my child to leave Camp Keaton before the end of the program due to illness, injury, or behavioral issues, and I cannot be reached, I hereby give permission for my child to be released into the custody of the person identified above. I understand that Camp Keaton may require photo identification of anyone who picks up my child from Camp Keaton, including myself.

I hereby release Camp Keaton, its staff, volunteers and representatives from liability for releasing my child the person identified above.

I understand and agree that, in the event of necessary health care or other emergency, Camp Keaton may release my child to health care professionals or other appropriate personnel.

I have read and understood this entire form, and I agree to be bound by the conditions of the agreement.

By checking this box, I hereby certify that the information within the 'Custody of Child' portion of the application is true and complete.

Type Full Name Here:

Date: (mm/dd/yyyy)

Media & Photo Posting Policy

Camp Keaton sends photographs to all campers and volunteers who attend camp each year as a memento of their time at camp.

Camp Keaton creates marketing and collateral materials to promote the camp and solicit funds from donors. These materials may contain photographs and/or videos of current and/or previous camps as well as statements/quotes obtained from campers, their families and/or volunteers. Camp Keaton protects the identity of any camper or volunteer currently or previously attending Camp Keaton in its reporting requirements and its marketing endeavors.

Camp Keaton does not release photographs, videos, statements or quotes of campers, their families and/or volunteers without the written consent of the individual(s) concerned. However, photographs and videos may be released without consent if the face of an individual is presented in such a way that makes it highly improbable that the identity of the person could be discerned. Similarly, statements or quotes may be released without consent when the full name and/or identity of the person is not revealed.

The following individuals will have access to all photographs, videos and interviews of Camp Keaton participants:

- Camp Keaton Director

- Camp Keaton Administrator

- The Dr. Bob Kemp Hospice

Photo Posting Policy:

We would like to remind you that photographs or video clips taken by Camp Keaton are considered Camp Keaton property. Parents and/or caregivers who have given consent for their children/teenager’s photographs to be distributed have done so ONLY for Camp Keaton Management. Campers, volunteers and staff cannot post Camp Keaton pictures on personal web pages, social media (i.e. Facebook, Instagram) or on public photo sharing websites (i.e. Kodak Gallery, Shutterfly or Caring Bridge) without written permission from Camp Keaton.

If photos or videos are found to be displayed on the Internet, in any capacity, without prior permission of Camp Keaton, the person responsible will be contacted immediately to remove the media content. Thank you for your understanding and cooperation in regards to this matter.

By checking this box, I hereby agree with the above-mentioned information regarding Camp Keaton's protocol for photo posting policy.

Type full name here:

Date: (mm/dd/yyyy)

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