Camp Firefly Application Form

September 20-21, 2025

at “Camp Manitou” (Headingley, MB)

Camp Firefly is a grief camp for children aged 6-17, offered at no cost to our grief campers and their families.

Please fill out every section below, and please provide us with as many details as possible. Those details will help us to create a grief camp experience that is tailored specifically to the wants and needs of the child in your care.

If you are applying on behalf of siblings or cousins etc., please fill out an application form for each child. And please indicate specific connections between the children. Camp Firefly can be exceptionally healing for young family members who attend it together.

Lastly, everyone who applies will be sent a responsive email. You and your child were brave enough to reach out to us and ask for help, so the least we could do is offer you full and respectful communication in return.

Thank you for prioritizing the well-being of your grieving child. That in itself is a beautiful gesture. ❤️

Child's full name

Birthdate:

Ethnicity/ancestry/culture/background:

Home neighbourhood/community:

School:

Who is your child grieving?

(Please write the name of the person who died and their relationship to the child. If they are actively grieving multiple deaths, please list them all)

When did their loved one die?

How did their loved one die?

(We know it can be hard to talk about this, but the more details you give us - the better we can support your child)

Has your child been told the full details of this death? If not, what have they been told?

(We will not disclose any additional information to your child unless you give complete and detailed approval. Navigating death and grief can be complicated for families. We know and respect that)

On a scale of 1 to 10, how comfortable is your child with expressing their grief?

(There are no wrong answers. Many of our grief campers aren’t comfortable talking about their grief at all, before they come to Camp Firefly)

Please list any mental/emotional struggles that your child may have:

(There are no wrong answers. All kids with all types of struggles are accepted to Camp Firefly. If you provide us with as many details as possible however, it will help us to support your child in the ways that they need and deserve)

Please list any physical disabilities/limitations:

(There are no wrong answers. Our host site, Camp Manitou, is extremely accessible for kids of all kinds. And so are we at Camp Firefly)

Is your child supported by any Support Workers in their community?

(Action Therapists, respite workers, mentors, counsellors, etc.). If so, with their permission, please list all names and organizations that support your child:

Would their support worker(s) be willing to accompany your child to Camp Firefly?

We will have lots of qualified support workers at Camp Firefly who are excited to work with your child. So bringing along an external support worker is not needed by any means. But we allow/encourage kids to bring their own support workers if they work closely with them in their home communities, and if it's helpful or wanted by the kids themselves. For some kids, this option is really helpful and has produced great success at our camp. For other kids, it's not wanted or needed. Every kid is different. External support workers can attend Camp Firefly at no charge. They would be provided food, drink, lodging, and anything else they need to be comfortable. But again, this is an option and not a requirement. Camp Firefly is fully staffed.

Any allergies?

Any specific food or drink needs we should know about?

Camp Firefly 2025 will be an overnight camp. It will run from Saturday morning (September 21st), to Sunday early evening (September 22nd). Would your child be comfortable sleeping overnight at Camp Manitou (with supports)? Or would they rather sleep at home and come back Sunday morning?

There are no wrong answers. We want all our grief campers to have the best possible experience at Camp Firefly, and we are fully adaptable to their wants and needs.

Anything else you'd like us to know?

Please list the name of the parent, caregiver, or worker who is filling out this form. If you work for an agency or organization, please list that as well.

And please explain your relationship to the child.

Parent/Caregiver/Worker email:

Parent/Caregiver/Worker phone # :

(###)

###

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How did you hear about Camp Firefly?

Please be as specific as you can. It helps us a lot