Support Angel Wings Retreat

There are many ways that you can help Angel Wings Retreat. Volunteers are needed to serve as camp counselors, activity leaders/assistant or general help. If you are interested in volunteering, fill out the form here. Watch the video below to learn more.

Your donation to Angel Wings Retreat will ensure that every child attends camp at no cost.

Applications are now being accepted by filling out the form below:

Child's Name*
First Last
Child's Date of Birth*
MM slash DD slash YYYY
Child's Mailing Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Has your child ever attended the Southcoast Health Angel Wings Retreat?*
- Yes
- No
If yes, How many times?
How did you learn about the Southcoast Health Angel Wings Retreat?
Child’s T-Shirt Size:
- Youth Small
- Youth Medium
- Youth Large
- Youth XL
- Adult Small
- Adult Medium
- Adult Large
- Adult XL
- Adult XXL
- Adult XXXL
Parent / Guardian Name*
First Last
Parent / Guardian Preferred Phone*
Parent / Guardian Email*
Parent / Guardian Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Emergency Contact Name*
First Last
Emergency Contact's Relationship to Camper:*
Emergency Contact's Preferred Phone Number for Days of Retreat*
Does your insurance mandate a Hospital?*
- Yes
- No
Hospital of choice?*
Does your child have any allergies? If yes, please provide specific allergies. If no put N/A. If your child has specific food allergies, please list them below.*
Does your child take medications? If yes, what are the medications treating? If no put N/A.*
Will your child be taking any medications at the retreat?*
- Yes
- No
Medical Disabilities (Please check any that apply.)
- ADD
- ADHD
- Autism
- Asthma
- Diabetes
- Headaches/Stomachaches
- Hearing Impaired
- Learning Disability
- Mobility Impaired
- Visually Impaired
Does your child have any of the following?
Other (Please Specify)
Is your child currently under the care of a physician?*
- Yes
- No
If yes, Physician’s Name and Phone Number*
What is the date of your child’s last tetanus shot?*
MM slash DD slash YYYY
BEREAVEMENT HISTORY
- Please include as many details as possible when answering the following questions. We understand that answering some of these questions might be difficult; however, we want to be able to provide the best possible care for your child.
Child’s Name*
First Last
Name of Deceased*
First Last
Relationship to child:*
Date of Death*
MM slash DD slash YYYY

* Death must have occurred prior to 4/24/2023.
Age of child at time of death*
Was the deceased receiving Hospice services at the time of death?*
- Yes
- No
Was the death anticipated or sudden?*
What was the deceased’s cause of death?*
Please check if the following statement is true:
- Child/Adolescent has not been told the facts about the deceased’s cause of death.
If checked, please explain what your child has been told about the cause of death
Is this your child’s first experience with death?*
- Yes
- No
If no, please comment on other deaths your child has experienced
Where did this person die?
Was the child present at the time of death?*
- Yes
- No
Did the child see the deceased after the death?*
- Yes
- No
Was there a funeral, wake or memorial service?*
- Yes
- No
If yes, did your child attend and what were your child’s comments/reactions to the service?
Did the child live with the deceased?*
- Yes
- No
How would you describe the child’s relationship with the deceased?
Does your child speak openly of the person who died?*
- Yes
- No
Please explain how your child shows that he/she is grieving.
Since this death, is your child displaying any behaviors/moods that have you concerned? If yes, please explain
Has your child exhibited any of the following since the death of the loved one? Check all that apply
- Withdrawn/Isolation
- Suicidal thoughts/talk
- Causing harm to self
- Behavior problems at school
- Behavior problems at home
- Loss of interest in usual activities
- Inappropriate sexual behavior
- Special fears
- Worries about his/her safety or safety of others
- Running away from home
- Headaches, stomach aches
- Nightmares
- Belief that death was his/her fault
- Belief that death is punishment
- Changes in interactions with others
- Drug/Alcohol use
- Destruction of property
- Changes in how he/she feels about self
- Causing harm to others
- Lying
- Stealing
- Anger
- Other
Other
Has your child received any professional support?*
- Yes
- No
If yes, is support currently being provided?
Other than this death, have there been any changes/stresses in your child’s life (i.e. illness, divorce, relocation, remarriage, finances, other losses?)*
- Yes
- No
If yes, please explain:
Has your child ever experienced abuse of any kind?*
- Yes
- No
If yes, please explain
Describe your child’s personality/character traits.*
Are there any other special needs, family customs, or cultural aspects to your child’s grieving that we should be aware of?

Supporting Children in Our Community with Southcoast Health Angel Wings Retreat in MA

Southcoast Health Angel Wings Retreat is a two-day bereavement camp in Assonet, MA for children and teens, ages 6 through 15 who are grieving the loss of a loved one.

The Angel Winis Retreat was developed for children and teens who share similar experiences with grief. The camp provides them with an educational, therapeutic experience that is also enjoyable. The camp helps counter a sense of isolation that children can feel after losing a loved one. Participating in activities such as swimming, focused arts and crafts activities, and small discussion groups can help children and teens explore their many thoughts and feelings about grief. It also encourages them to try new or familiar activities that help them feel good about themselves.

Our camp activities include:

Swimming
Team building
Sharing of loss
Focused arts and crafts
Activities memorializing loved ones
Breakfast, lunch and snacks

In addition to fun-filled activities, the Southcoast Health Angel Wings Retreat:

Gives children and teens the opportunity to remember their loved ones
Is staffed by Southcoast VNA Supportive Care Center staff, trained volunteers and caring members of the community
Allows boys and girls to be themselves and grieve without feeling pressured
Helps reduce the sense of isolation while improving self esteem

Through Southcoast VNA, the Angel Wings Retreat provides bereavement support to children in the South Coast community.