Camp Robin Lourdes Hospice

Registration of children who will attend

Please list all children who will attend camp (Please list ages; each camper will be divided into age appropriate groups)

Child #1 (Name and Age)

Child #2 (Name and Age)

Child #3 (Name and Age)

Child #4 (Name and Age)

Child #5 (Name and Age)

Registration of adults who will attend

Adult #1

Adult #2

Adult #3

Adult #4

Please share with us the name & relationship (to the child/children) of the loved one(s) you will be honoring:

Name and Relationship of Honored Loved One

Contact Information

We would like to be able to send out information on CAMP ROBIN in the future to our campers. In order to help us do that, please list the following below:

Name of Primary Adult Contact:

First Name

Last Name

Mobile Number

Street Address

Address Line 2

City

State

Postal / Zip Code

Camp Robin continues due to donations and grants received. In order to apply for grants we report the following information. You do not have to answer but it does help us greatly.

County of Residence

Race

Gender

Please share how you heard about Camp Robin- hospice, newspaper, school, online, etc.

How did you hear about us?

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