Nathan Adelson Hospice
Register for Camp Cope Form

In partnership with Adam’s Place, Nathan Adelson Hospice provides the Camp Cope Program.

Once you submit your Camp Cope registration, you will receive an email communication to schedule your Camp Cope orientation.

Nathan Adelson Hospice's Camp Cope will be held in person at:
4141 S University Center Drive, Las Vegas, NV 89119.

Nathan Adelson Hospice - Sign Up For Support

Your Name *

First

Last *

Last

Email *

Phone *

Address *

Address

City

State/Province

Zip/Postal

Name of Deceased *

Relationship to the Deceased *

Cause of Death *

Date of Loss *

Details of Circumstance *

Do your children understand the circumstances of the loss? *

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

Full Name *

Age *

Birthdate

School & Grade

Gender Identity

Add Remove

Please wait a moment after clicking Add/Remove for the new field set to appear/disappear.

Camp Cope

Is your child participating in Camp Cope at their school? *

Yes

If yes, name of school

Camp Cope Permission
My child has my permission to attend Camp Cope sessions with Nathan Adelson Hospice and 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.

Name of Parent/Guardian (signature) *

Confirm Signature *

By checking this box, I confirm that I am giving permission and this counts as my signature

Today's Date *

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

Name of Parent/Guardian (signature)

Confirm Signature

By checking this box, I confirm that I am giving permission and this counts as my signature

How did you hear about Camp Cope? *

ORIENTATION MEETINGS

You will be contacted by the team with Nathan Adelson Hospice to schedule a virtual Family Orientation.

At orientation, you will have the opportunity to learn more about Nathan Adelson Hospice's Program, Adam's Place and Camp Cope. You will also receive the meeting information at this time.

We look forward to meeting you!

Join Our Email List?

Yes, please keep me informed.

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Nathan Adelson Hospice Register for Camp Cope Form

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

ORIENTATION MEETINGS

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Nathan Adelson Hospice
Register for Camp Cope Form