Camp GLOW Grief Support Registration | Wisconsin

Now accepting applications for 2026.

Register online for Camp GLOW (Giving Loved Ones Wings), a day camp for grieving children and the grown-ups who love them.

Fields that include an asterisk (*) are required. Please complete a registration form for each camper who will be attending.

Register For A Camp

Please choose the camp you are interested in attending:* Baraboo (May 16, 2026) Waunakee (September 26, 2026)

Camper Information

Camper's t-shirt size* Child Small Child Medium Child Large Adult Small

Camper's gender Female Male

Sibling Information

Camper does not have siblings.

Relationship to camper:

Additional Siblings

Relationship to camper:

Bereavement History

(Home, hospital, etc.)

Was the camper present at the time of death? Yes No

Did the camper get to say goodbye to the deceased? Yes No

Did the camper attend the funeral? Yes No

Has the camper experienced other deaths? Yes No

Has the camper received any professional counseling/support? Yes No

Have there been any other changes/stressors in the camper's life, or other pertinent information you would like to share? Yes No

(Separation, divorce, remarriage, move, change in schools, illness, etc.)

How has the camper indicated he/she is grieving?

What are your hopes/expectations for the camper in attending Camp GLOW?

Please describe the camper's personality, hobbies, struggles, talents, etc.

Camper Health Information

Does the camper have any food allergies?* Yes No

If yes, provide severity, reactions and any other information:

Does the camper have any drug allergies?* Yes No

If yes, provide severity, reactions and any other information:

Does the camper have any dietary restrictions?* Yes No

If yes, please list restrictions:

Emergency Contact Information

Phone type:

Parent/Guardian Information

Is this the camper's home address?* Yes No

Phone type:

Contact preference:

Please select a t-shirt size for the parent/guardian.* Adult Small Adult Medium Adult Large Adult X-Large Adult XX-Large Adult XXX-Large

Parent/Guardian Health Information

Any food allergies?* Yes No

If yes, provide severity, reactions and any other information:

Any dietary restrictions?* Yes No

If yes, provide severity, reactions and any other information:

Additional Adult Attending Camp

No additional adults will be attending with the camper.

Phone type:

Contact preference:

T-shirt Size Adult Small Adult Medium Adult Large Adult X-Large Adult XX-Large Adult XXX-Large

Additional Adult Health Information

Any food allergies? Yes No

If yes, provide severity, reactions and any other information:

Any dietary restrictions? Yes No

If yes, provide severity, reactions and any other information:

Media Consent*

By signing this form you are giving consent to SSM Health at Home, its affiliates, agents, and/or news media, to use your name, image and likeness and/or any interview statements from you in its publications, advertising, or other media activities. This consent includes but is not limited to: Audio Recording, Motion Pictures, Photographs, Electronic Images, Live Broadcast, Interview/Print, and may be obtained by SSM Health at Home or by a media representative directly.

By signing this authorization, you waive any right to compensation for such uses, and you and your successors or assigns also release and hold harmless SSM Health at Home from and against any claim for any injury in connection with the use, copying, distribution, or display of your image, voice, likeness, name, or any other identifying characteristics in the broadcast or publication and any compensation resulting from the activities authorized by you in this authorization.

If you change your mind at any time, you can revoke this authorization by sending a written notice stating you are revoking your authorization to SSM Health at Home Marketing Department (4639 Hammersley Rd, Madison, WI 53711). It will be effective upon receipt.

I have read the media consent statement and I consent for myself and my minor children. I have read the media consent statement and I do not consent.

2026 Camp GLOW information:

Camp GLOW is offered at no cost, thanks to support from the SSM Health at Home Foundation of Wisconsin.

Baraboo | Saturday, May 16

10 am – 3 pm
Ochsner Park
903 Park Street
Baraboo, WI 53913

Registration deadline: May 8

Waunakee | Saturday, September 26

10 am – 3 pm

St. John the Baptist School

114 East Third Street

Waunakee, WI 53597

Registration deadline: September 18

Contact us:

To learn more contact us at 800-924-2273.

Camp GLOW Registration

Now accepting applications for 2026.

Register For A Camp

Camper Information

Sibling Information

Additional Siblings

Bereavement History

Camper Health Information

Emergency Contact Information

Parent/Guardian Information

Parent/Guardian Health Information

Additional Adult Attending Camp

Additional Adult Health Information

Media Consent*

2026 Camp GLOW information:

Baraboo | Saturday, May 16

Waunakee | Saturday, September 26

Contact us: