Phone (402) 488-8989

What We Do

Camp Erin Family Camp Registration

Camp Erin Family Camp 

This overnight camp at the Lied Lodge is for families who have experienced the death of someone significant in their lives. Priority will be given to frontline healthcare workers and other families grieving the death of someone from COVID-19, as well as families who experienced a death in 2020 and following. 

Days: Saturday, April 22 & Sunday, April 23 (WAITLIST)
Time: Arrive at 1 p.m. Saturday, depart at 11:30 a.m. Sunday
Location: Lied Lodge at Arbor Day Farm | Nebraska City, Nebraska

Space is limited. Applications must be received by Friday, March 31, 2023. All youth attendees must be age five or older, and at least one adult caregiver must attend.

Mourning Hope will review all applications following the March 31 deadline, and will respond regarding acceptance during the first week of April.

Family Camp Registration Form

First Youth Attending
Month
/
Day
/
Year
Youth's School
Youth's Grade
Youth's Age
Youth's Gender
T-Shirt Size
Please list any food allergies and/or dietary restrictions for this camper:
If none, write N/A.

 

Second Youth Attending
Month
/
Day
/
Year
Youth's School
Youth's Grade
Youth's Age
Youth's Gender
T-Shirt Size
Please list any food allergies and/or dietary restrictions for this camper:
If none, write N/A.

 

Third Youth Attending
Month
/
Day
/
Year
Youth's School
Youth's Grade
Youth's Age
Youth's Gender
T-Shirt Size
Please list any food allergies and/or dietary restrictions for this camper:
If none, write N/A.

 

Fourth Youth Attending
Month
/
Day
/
Year
Youth's School
Youth's Grade
Youth's Age
Youth's Gender
T-Shirt Size
Please list any food allergies and/or dietary restrictions for this camper:
If none, write N/A.

 

First Name *
Last Name *
T-Shirt Size
Please list any food allergies and/or dietary restrictions for this camper:
If none, write N/A.

 

First Name
Last Name
T-Shirt Size
Please list any food allergies and/or dietary restrictions for this camper:
If none, write N/A.
Country
Address Line 1 *
Address Line 2
City *
State/Province *
Postal Code *
Cell Phone
Parent/Guardian/Caregiver(s) Employer(s)
Preferred method of contact:
Is someone in your family who is attending camp a frontline healthcare worker?
Is someone in your family who is attending camp a member of the military?
Is English the primary language spoken in the home?
Name of person who died
Must be between January 2020 and March 2023.
Was this a COVID-19 death?
Circumstances of death
How has your family's grief journey been impacted by the pandemic?
I.E.: Limited access to support, inability to host a funeral/memorial, unable to say goodbye, etc.
Was there a funeral/memorial service?
If "Yes", did the child(ren) attend the funeral/memorial service?
Other changes in your lives
Are there other health concerns or restrictions we should be aware of? If so, please detail here.
If none, please write N/A.
Does anyone in the family need accessibility accommodations?
First Name *
Last Name *
This must be someone who is not attending camp.

Funding agencies often require nonprofit organizations to maintain client information related to gender, race, age and income level. The requested information is strictly for the purpose of Mourning Hope's compliance with these record-keeping requirements. Responses will remain anonymous, and are greatly appreciated.

Age(s) of Participant(s)
Please check all that apply:
Race(s) of Participant(s)
Please check all that apply:
My Child Receives Free/Reduced Lunch at School
By typing your name in the signature box, you are giving consent to participate. You will receive a separate consent form to complete related to online support groups. The term "electronic signature" means a method of signing an electronic message that identifies and authenticates a particular person as the source of the electronic message; and indicates such person's approval of the information contained in the electronic message.