2021 Dinner

Name of Officer

Date of Death

Attendee Information

Please tell us about the immediate family members that will attend the events. Immediate family is defined as parents, step parents, children, siblings and spouses.

Your Name*

First Last

Relation to the Officer

Number of immediate family members in your group*

Immediate family is defined as parents, step parents, children, siblings and spouses.

Email*

COVID*

Help us understand how COVID will affect your travel plans.

Attendee2

First Last

Attendee2 Age

Attendee2 Relation to Officer

Attendee3

First Last

Attendee3 Age

Attendee3 Relation to Officer

Attendee4

First Last

Attendee4 Age

Attendee4 Relation to Officer

Events

The events below are support groups/activities that are designed for the immediate family that lost the officer to suicide. This is defined as parent, sibling, children, spouse/significant other Please let us know what events you would like to attend. These events will be customized to your peer group.

Number of Children under 18 who lost a LEO parent that will attend the camp Thursday and Friday, September 23 and 24

PLEASE NOTE: This is only for the children of the LEO lost to suicide. At this time, it does not include grandchildren, nieces and nephews. If you plan to attend the camp, you will arrive Wednesday and depart Sunday. Unfortunately, we are unable to have kids attend just one day, they would need to attend both days.

Number of Spouses/Significant Others that lost a LEO to suicide that will attend events Friday, September 24

PLEASE NOTE: This is for spouses/significant others that lost an officer to suicide. This does not include brother or sister-in-laws. If you plan to attend this activity and do not have kids in the camp, you will arrive Thursday and depart Sunday.

Number of Parents/Step Parents of adult children lost to suicide that will attend events Friday, September 24

PLEASE NOTE: If you plan to attend this activity and do not have kids in the camp, you will arrive Thursday and depart Sunday.

Number of Adult Siblings who lost an officer to suicide that will attend events Friday, September 24

PLEASE NOTE: If you plan to attend this activity and do not have kids in the camp, you will arrive Thursday and depart Sunday.

Number of Adult Children who lost a parent to suicide that will attend events Friday, September 24

PLEASE NOTE: If you plan to attend this activity and do not have kids in the camp, you will arrive Thursday and depart Sunday.

We will attend the dinner only

PLEASE NOTE: If you plan to attend the dinner only, you will arrive Friday and depart Sunday.

Travel

All families will receive ONE room each for the nights of their stay. For instance, if you are participating in the kids camp, you will be provided one room for arrival on Wednesday and departure on Sunday. If you are participating in the Friday events, you will have one room to arrive Thursday and depart Sunday. Blue H.E.L.P. will only provide rooms for the nights of the planned activities.

Travel to Dallas*

Travel assistance is only available to immediate family members - parents, spouses, significant others, siblings, and children. Assistance is not available to in-laws or anyone not defined as an immediate family member. If you need assistance for airfare, train, gas or other mode of travel to the event. We will have some assistance available to each family. We can provide that information once we have a firm headcount.

What state are you traveling from?*

Comments, Notes, Special Circumstances

Please let us know of any allergies, handicap accessible needs, or any thing else that would help us accommodate you.

Annual Dinner

Attendee Information

Events

Travel

Comments, Notes, Special Circumstances

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