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JUN 11, 2017 - JUN 14, 2017
Eastern North Carolina 4-H Conference Center - Columbia, NC


Mentor Information
Thank you for volunteering to assist the children of our fallen military. We truly appreciate your support and want to learn more about you and your interests to better serve you and our kids!
PLEASE NOTE: If you register as a mentor, you would need to be available for the entire event during the dates and times of the Good Grief Campout.
If you have any questions, please don’t hesitate to contact TAPS at or 800-959-8277.

* Required Information
*First Name:
*Last Name:
*Name Tag (FIRST NAME Only):
*Email Address:
*Confirm Email Address:
Please enter your current mailing address. Be sure to separate the house number from the street name. We will use this address to mail your certificate of completion.
*Address House Number:
i.e. 4410
*Street Name:

i.e. Drury Ln ; 2nd St SE ; Route 50
Address 2:
*Zip Code:
*Primary Phone:
*Cell Phone:
We want to learn more about you and your interests to better serve you and our kids. Please provide us with the following information.
*What is your gender:
* You will be given a TAPS T-Shirt to wear during the TAPS Good Grief Campout! Please provide your T-Shirt size. (T-Shirts are unisex, so females may want to order smaller than normal size).
Please list any special dietary needs you would like us to know about (i.e. Food Allergies, Vegetarian, Diabetic, etc.) Please Note: Due to sponsor food donations we cannot always accommodate all dietary restrictions.
Military Service
*Military Service:
*What branch of the service are/were you a part of?
If you selected 'Other' for Branch, please explain:
Current Duty Station:

i.e. Fort Drum, NY
Division or Major Command AND Unit (if applicable):

i.e. 10th Mtn Div, 3rd Brigade, 2-87 Infantry
*Have you been deployed to a combat zone?

Please provide either your Commander OR Employer's name and full address and Email so we can send a letter of appreciation for your participation as a Mentor in the Good Grief Camp.
Rank OR Title:
Full Name:
Mailing Address 1:
Mailing Address 2:
Employer Phone:
Employer Email:
Good Grief Camp Information
*Is this your first time volunteering at the Good Grief Camp?

*In what year did you first volunteer for TAPS?
*How did you hear about TAPS?
*What persuaded you to volunteer for the Good Grief Camp?
If you lost someone close to you, we are sorry for your loss. We are grateful you have offered to spend your weekend supporting children who have lost loved ones as well. We know this may be difficult and want to be supportive of you too.
*Have you lost a friend or loved one recently?

What was your relationship with them?
If your loved was was serving in the military, please provide their name:
GGC Mentor Role
*What will be your Role? Please only select Senior Mentor or Group Leader if we have asked you to specificially.
If you selected "other", please specify what other roles you will perform:
* Please tell us the age of children you would most like to work with. We will do our best to put you in that group. You may check as many as you like, but please note that you MUST be at least 25 years old to work with the teen groups.

*Please tell us about any experience you have working with children. Include any experience as a parent, older sibling, coaching, scouting, etc.
Please tell us about any experience you have working with children who have special needs.
If bilingual, please list what language(s) you speak.
Please list any certifications you hold (i.e. CPR, Lifeguard, etc.) that would be applicable to mentoring a child. You may also provide any additional information about yourself that you would like to share with us.
If you have worked with a child at a previous TAPS event and have continued your support to them, please list their name here. (NOTE: This is not a guaranteed match).
Child's Name (first & last name only):
Training is MANDATORY and tentatively set for 12:00on on Sunday, June 11th. Lunch will be provided.
* Mandatory Training - if you are unable to attend training you will not be able to mentor a child.

All lodging, parking, and meals will be provided - you will be staying in cabins. Please note, however, that bedding and toiletries are not provided. A suggested packing list, directions to the camp, and more information will be sent to you early June.
TAPS will have volunteer photographers taking pictures at this event.
* TAPS will have volunteer photographers taking pictures at the Good Grief Campout. These photographs may be used for informational and educational purposes in our efforts to reach out to provide comfort and care to all in need of support. I give TAPS, its agents and licensees permission to photograph, videotape, and/or interview me and all other adults listed on this registration form during the Good Grief Campout. TAPS may use this material for future public education and/or publicity purposes, and may be released to those media outlets TAPS deems appropriate.
Please let us know if you would like to receive text messages from TAPS. Our text messages are intended for subscribers over the age of 18 and are delivered via USA short code 95577. You may receive up to six text messages per month. Normal text messaging rates apply through your carrier. You can read the full text messaging disclosure on our website.

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