Free support for grieving children, aged 5-17.
Children in our programs have experienced the death of a family member
or friend due to illness, suicide, homicide or tragic accident.
Contact the site nearest you
for more information:
Camp Erin is a
The Community Hospice
of Albany/Schenectady
445 New Karner Road
Albany, NY 12205
Phone: 518-724-0200
free overnight weekend
camp for children grieving
the death of a family
member or friend. Sixty
children attend annually.
The Community Hospice
of Amsterdam
246 Manny Corners Rd.
Amsterdam, NY 12010
Phone: 518-843-5412
Applications are due July 1st
Camp Erin 2015 dates:
Friday September 25th Sunday September 27th
The Community Hospice
of Columbia/Greene
47 Liberty Street
Catskill, NY 12414
Phone: 518-943-5402
The Community Hospice
of Rensselaer
295 Valley View Blvd.
Rensselaer, NY 12144
Phone: 518-285-8100
The Community Hospice
of Saratoga/Washington
179 Lawrence Street
Saratoga, NY 12866
Phone: 518-581-0800
Applications are available
on our website:
HOSPICEFORKIDS.COM
When/Where:
5:00pm - 6:30pm
Mondays in
Schenectady
5:00pm - 6:30pm
Tuesdays in
Amsterdam
5:30pm – 6:45pm
Thursdays in
Saratoga
5:30pm – 7:15pm
Tuesdays in
Albany
5:00pm - 6:15pm
Wednesdays in
Rensselaer
2015 Dates:
February 23 March 30
Wave Riders is a free six week
support group for grieving children.
February 24 March 31
February 26 April 2
April 14 May 19
April 15 May 20
Families may attend any location.
Children must attend all sessions with a
parent or legal guardian.
Wave Riders
Additional Services:
Individual Support Sessions
Family Support Sessions
Support Groups for Adults
Memorial Services
Crisis Response
Education
Outreach
Pediatric Bereavement Services Application – Online version available: HospiceForKids.com
First and Last
Name (of adult):
Relationship to
children below:
Date of birth:
Ethnicity:
Parent / Other:
Mailing Address:
Phone
Number:
City:
Zip Code:
Email Address:
Referred By:
Child’s First Name
Child’s Last Name
Age
M/F
Ethnicity
Name of the
person who died:
Date of Birth
Grade
School
Date of death:
Cause of death:
Relationship:
The person who
died is your child’s:
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Father
Mother
Grandfather
Grandmother
Brother, age:___
Sister, age: ___
Cousin
Aunt/Uncle
Other:
Children’s behaviors since the death?
Services you are requesting:
Preferred location:
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Changes in sleep patterns
Over or under eating
Clinging to adults or anxiousness
Behaving younger than age
Physical or aggressive behavior
Anger at self or others
Camp Erin
Wave Riders
Individual Support Sessions
Family Support Sessions
Support Groups for Adults
Other:
Difficulties with peers or family
Risky or destructive behavior
Albany
Schenectady
Rensselaer
Amsterdam
Saratoga
Catskill
At school
Any additional information:
Ran away from home or school
Refusal to talk about deceased
Obsession with death
Inappropriate sexual behavior
Discussed or attempted suicide
Other:
Did your love one receive any Hospice patient services?
Do any of your children have any allergies?
Are there any medical or physical conditions?
Are there any behavioral or mental health conditions?
Is your household considered low income? <$34,575
Y
Y
Y
Y
Y
N County:
N
N
N
N
I hereby give permission for all the children named above to receive services from The Community Hospice.
Please clearly PRINT Parent/Legal Guardian’s Name:
Today’s Date:
Signature: