Get documents about "KA PILINA PUˉLAMA Family Camp - Hospice Hawaii
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BRING HOPE • REDUCE FEARS • IMPACT LIVES
What is Family Camp? Hospice Hawaii’s annual Family Camp is
for children and teens (7-17) and adults who have experienced
the death of a loved one. In a safe and supportive environment,
they explore their loss with other families touched by grief.
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KA PILINA PULAMA They learn to communicate and face the ‘unthinkable’ through
a curriculum that integrates mentoring, the arts and lots of
Family Camp camping fun. They discover in this journey from loss and grief
to remembrance and healing, that they can thrive again in a
changed world with a new relationship to their loved one.
What are the key elements?
• Individual Family Way-finders: Each family is paired with
a Family Way-finder who mentors and supports them to
prepare for camp and accompanies them throughout the
three day camp.
• Family support groups: Through crafts and activities family
members learn to grieve together and discover they are
not alone.
• Coping strategies: Facilitators model accepted psychological
strategies to communicate and express grief in healthy ways.
It is okay to have fun while actively grieving.
• Memorials: Families learn to express their loss through ritual
that honors their loved one and binds them together.
When must the application be received and how much does it
cost? Applications must be received by April 30, 2012. You will
be contacted shortly thereafter. The Camp fee is $50 per family;
Family Camp: June 22–24, 2012 limited scholarships available.
53-516 Kamehameha Hwy. Where and when is the 2012 Camp held? The Camp grounds
are on the Hau’ula campus of the Queen Liliu’okalani Children’s
Our Annual Family Camp is for families with children and If you are interested in attending the program, please contact Center, 53-516 Kamehameha Hwy. Camp opens on Friday,
teens 7-17 years old who have lost a loved one to death. Camp Hospice Hawaii’s June 22 at 2:00 PM and ends on Sunday, June 24 at noon.
provides a balance of fun activities and introspective grief Bereavement Coordinator To contact us: Please call the Bereavement Coordinator at
exercises to assist families in their journey from loss and grief, at 808-791-8029 (808) 791-8029; or email us at familycamp@HospiceHawaii.org
to remembrance and healing. familycamp@HospiceHawaii.org Hospice Hawaii is a not-for-profit Internal Revenue Code 501(c)
The camp’s name Ka Pilina Pulama was given to honor our island
¯ or visit www.HospiceHawaii.org (3) organization with a strong 30 year history of providing end-
heritage. It signifies that we are connected to the land, the of-life care and services to Hawaii’s families. Our first camp was
heavens, and each other. This sustains and holds us through the held in 1998 in response to a community need to strengthen
darkest nights. bonds in grieving families. The Camp faculty is comprised of
professional hospice staff and volunteers, screened and trained
#96290 #93802
Last Day To Apply: April 30, 2012 1211-10
by our Patient and Family Services Department.
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KA PILINA PULAMA Family Camp
Family Name: Parent/Guardian E-Mail:
Address: City: Zip:
Parent/Guardian’s Name: Day Phone: Cell Phone:
Emergency Contact: Day Phone: Cell Phone:
Doctor’s Name: Phone:
Medical Insurance Company Membership No.
Birthdate Gender Allergies/ T-Shirt Size
Youth’s Name Mo/Yr Circle Current Grade Special Needs Circle One / Circle One
1) m/f Youth or Adult / S M L XL
2) m/f Youth or Adult / S M L XL
3) m/f Youth or Adult / S M L XL
4) m/f Youth or Adult / S M L XL
5) m/f Youth or Adult / S M L XL
ADULT ATTENDING NAME Youth or Adult / S M L XL
Name of the person who died? Relationship to child
What was the cause of death? Date of death
How old was your child when the death occurred? (list name & age)
In the past 2 years, list other losses your child has experienced (pets, divorce, relocation, other relatives)
Has your child received any professional support (School Counselor, Social Worker, Therapist, Psychologist, Minister, etc)? (list name and professional)
Consent: I hereby give my permission to have myself, my child/children recorded, photographed, and/or videotaped in connection with any activities of Hospice Hawaii Family
Camp. I give additional consent for Hospice Hawaii to use any photographs, audio/video tapes, or work (i.e., drawings, poems, etc.) in an informational presentation, newsletter,
or in the Annual Report. I also understand that the photographs, audio/video recordings are the property of Hospice Hawaii.
In consideration for my own, and/or my child/children’s participation in the above noted group, I hereby release, hold harmless and indemnify Hospice Hawaii Family Camp staff
and volunteers from and against all claims, including but not limited to claims for property damage and/or personal injuries arising out of my own and/or my child/children’s
participation in the group and activities, or the rendering of any medical treatment. I understand that Hospice Hawaii will make reasonable attempts to notify me or the
emergency contact as soon as possible in the event of illness or injury to my child/children.
My signature below indicates that I have read, understand, and agree to all the above and approve of my child/children’s participation in the Hospice Hawaii Family Camp 2012.
Parent/Guardian Signature: Date:
All campers must be 7 – 17 years old. Fees: $50.00 per family BY April 30th. Limited scholarships available. If you need assistance please contact Bereavement Coordinator,
808.791-8029, or visit familycamp@HospiceHawaii.org
Referred by Agency
Please make checks payable to “Hospice Hawaii/Camp” and mail to Hospice Hawaii, Attention: Bereavment Coordinator, 860 Iwilei Road, Honolulu, Hawaii 96817.
