hospice care
Spanish spanish language version
Call Us Today
1-(800)-HOSPICE

Camp Coral Application

Our bereavement counselor will contact you to schedule a screening.

Call (800) HOSPICE ((800) 467-7423) for help with this form or for phone RSVPs
Camper’s Full Name
Date of Birth     Sex     Age     Grade
Home Address
City    Zip    State
Name of Parent/Legal Guardian
Home Phone  
Cell Phone  
E-mail
Name of School
Name of School Counselor
Name of Deceased
Relationship to Camper
Date of Death
Was the death anticipated?
Cause of Death

Camp Coral