Young Adult Backpack Application

Young Adult Backpack Application

Thank you for your interest in joining us for our Young Adult Backpacking Trip. We are available to help with this application. If you need help or have any questions, call/text us at 360-358-3213 or email info@wildgrief.org.
Before completing this application, you must review the eligibility criteria. If you have questions about your eligibility, please contact us via phone or email prior to filling out the application. If you do not think you meet the requirements, please reach out to us about other Wild Grief program options or referrals to other grief support.
Have you reviewed the eligibility criteria and believe you meet all requirements?

Yes, I reviewed and understand the eligibility criteria and believe I meet all requirements.
Your Name*

First NameLast Name
Your Preferred Name
Your Pronouns
Birth Date*

MonthDayYear
Date
Mobile Phone*
Best Other Phone
Email*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
For participant and guide safety, we are requiring all guides and participants on this trip to be fully vaccinated (2 weeks post second dose) now that vaccines are widely available for ages 12+. Is the already fully vaccinated or willing to be prior to the trip?

Yes, I am fully vaccinated.Yes, I am willing to be fully vaccinated by the first day of their trip.No, I am not vaccinated and will not be fully vaccinated before the trip.Other
Below are questions about the death and how you are doing. These questions will help us understand how we can provide the best experience for you. There are no right or wrong answers. Please be as honest as you can. This information is confidential and will not be shared outside of Wild Grief. We will be sharing it with the guides on your trip.
Who died, how did they die, and what was their relationship to you?*
What were the circumstances of the death? How did the person die?*
When did the death occur? (Month/Year)*
Date of death*

MonthDayYear
Do not need the exact date
What should we know about you and your grieving?*
What, if any, other grief support have you done? (Example: Counselor, Peer Grief Support Group, grief camps, talk with friends, etc)*
What do you hope you will get from this trip?*
What, if any, concerns do you have about this trip?*
Describe your experience with camping, backpacking, or hiking (no experience necessary)?*
Anything else you would like to share?*
Wild Grief’s programs are funded by grants. You can help keep our programs available and free of charge by answering the questions below to help our funders understand who we are serving. We will share only the combined results with our funders, without identifying you. This information will also help us improve our programs. All questions are optional, and you may decline to answer.
What county do you live in? (Washington residents only)
How did you first hear about us?*

CounselorWeb SearchFacebookInstagramOther Grief GroupPast ParticipantFriendFamilySpiritual/Religious CommunitySchoolOther
Please select your race/ethnicity (select all that apply)

African American / BlackAsianNative AmericanHispanic/LatinoCaucasian/WhiteBi-Racial/Multi-RacialOther
Please select your race/ethnicity (select all that apply)*

American Indian or Alaska NativeAsianBlack or African AmericanMiddle Eastern or North AfricanNative Hawaiian or Pacific IslanderHispanic or LatinoWhiteDecline to answerOther
What is your primary language?
What County do you live in?
What is your gender?

WomanManTransgender WomanTransgender ManNon-BinaryAgenderDecline to answerOther
Gender*

MaleFemaleNon-binaryDecline to answerOther
Household Income*

< $30,000$30,000-$50,000$50,000-$80,000> $80,000Decline to answer
Does you identify as having a disability?

YesNoDecline to answerOther
If yes, is there anything you'd like to share about your disability and how we can make this trip more accessible to you?
Thank you for applying to join us on the trail. You must also submit the Medical/Emergency Form to complete the application process.

Once all forms are submitted, we will review them and contact you about the next steps in the application process.

By signing below you are agreeing to the following: All the answers I have provided in this application are true.
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