Orientation Registration Form

The first step is to register for our Camp Cope Family Orientation. You will then be taken to a video that you can watch at your own pace. Once don’t please acknowledge that you watched the video and you will be able to register for a Camp Cope Support Group.

Camp Cope Family Orientation
First
Last
Address *
Address
City
State/Province
Zip/Postal
Ethnicity
Are you a veteran?
Do you live within the city limits of Las Vegas?
Do you live within Clark County?

If the cause of death was related to opioid abuse, please check the box below. Adam's Place may have additional resources available for you and your family.

Please list all participating family members, including yourself, other adults, teens, and children.

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Ethnicity
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Camp Cope

Is your child participating in Camp Cope at their school? *
Camp Cope Permission
My child has my permission to attend Camp Cope sessions with Adam’s Place. I understand that these sessions are strictly peer grief support and are not therapy or counseling. Our emphasis is on coping skills education and support, giving the child a safe confidential place to share.
Confirm Signature *

Model Release
In exchange for consideration received, I hereby give permission to Adam’s Place AKA Camp Cope to use my name in photographic likeness in all forms and media for advertising trade, and any other lawful purposes.
Confirm Signature

ORIENTATION MEETINGS

At our Family Orientation you will learn a little more about Adam's Place and our Camp Cope program. We look forward to meeting you. Family Orientation is scheduled throughout the school year and is held virtually on Zoom. You will receive an email with the Zoom invite before the Orientation.

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