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Dempsey Center›Registration Forms›Space to Breathe Camper Info

Space to Breathe Camper Info

Thank you for your interest in the Dempsey Center’s Space to Breathe 2025! Space to Breathe offers an enriching adventure-based overnight program designed for teens aged 12-18 (entering 6th grade-12th grade) who have been impacted by a parent or sibling’s cancer.
Camper Name:(Required)
MM slash DD slash YYYY
Emergency Contact #1:(Required)
Emergency Contact #2
Does your child have any diagnosed medical or mental health conditions?(Required)
Does your child have any food allergies, sensitivities, or dietary restrictions?(Required)
List any food allergies, sensitivities, or dietary restrictions:
Food:
Details:
 
Does your child have any allergies (medication or environmental)?(Required)
List any medical or environmental allergies:
Allergy:
Details:
 
Does your camper have any medications (prescription or over the counter) they are currently taking?
List the name, dosage and administration instructions:
Medication Name:
Dosage:
Administration Instructions:
 
Please be prepared to send all medications to camp in their original prescription containers with camper’s name and dosing instructions and/or labelled in original over the counter containers. This includes any epi pens, inhalers, or other PRN medications.
Does your child need any special accommodations to be successful at camp?(Required)
Is there anything else it is important for us to know about your child or your family situation currently?(Required)
Camper’s T-Shirt Size (adult sizes):(Required)

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Navigate
  • How To Begin
  • All Programming
  • Classes and Workshops
  • Dempsey Challenge
  • About
  • Donate
  • Financial Transparency
  • Contact Us
Find Us

Lewiston
29 Lowell Street
Lewiston, ME 04240

1-877-336-7287

Hours:
Mon: 8:00 AM - 5:00 PM
Tues: 10:00 AM - 7:00 PM
Wed: VIRTUAL ONLY (8:00 AM - 5:00 PM)
Thurs: 8:00 AM - 5:00 PM
Fri: VIRTUAL ONLY (8:00 AM - 12:00 PM)
Sat-Sun: Closed

Rock Row - Westbrook
11 Rock Row, Suite 410
Westbrook, ME 04092

1-877-336-7287

Hours:
Mon: 8:00 AM - 5:00 PM
Tues: 10:00 AM - 5:00 PM
Wed: 8:00 AM - 5:00 PM
Thurs: 8:00 AM - 7:00 PM
Fri: VIRTUAL ONLY (8:00 AM - 12:00 PM)
Sat-Sun: Closed

Find Us

Lewiston
29 Lowell Street
Lewiston, ME 04240

1-877-336-7287

Hours:
Mon: 8:00 AM - 5:00 PM
Tues: 10:00 AM - 7:00 PM
Wed: VIRTUAL ONLY (8:00 AM - 5:00 PM)
Thurs: 8:00 AM - 5:00 PM
Fri: VIRTUAL ONLY (8:00 AM - 12:00 PM)
Sat-Sun: Closed

Rock Row - Westbrook
11 Rock Row, Suite 410
Westbrook, ME 04092

1-877-336-7287

Hours:
Mon: 8:00 AM - 5:00 PM
Tues: 10:00 AM - 5:00 PM
Wed: 8:00 AM - 5:00 PM
Thurs: 8:00 AM - 7:00 PM
Fri: VIRTUAL ONLY (8:00 AM - 12:00 PM)
Sat-Sun: Closed

Donations

Donations may be mailed to:
Dempsey Center
PO Box 277
Auburn, ME 04212
Checks should be made out to the Dempsey Center, please do not mail cash.
EIN Number: 82-1547129

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Donations

Donations may be mailed to:
Dempsey Center
PO Box 277
Auburn, ME 04212
Checks should be made out to the Dempsey Center, please do not mail cash.
EIN Number: 82-1547129

Presented in part by

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