CAMP FROZEN CHOZEN - CAMPER APPLICATION

Note: Receipt of this application does not guarantee acceptance into camp.  All applications will be subject to acceptance based on order of receipt.  Siblings and non-effected children of parents will be accepted when space availability permits.  You will be notified of acceptance.

All communication will be conducted via email.  If no email address is provided, documents will be sent via US Mail.  Please be sure email and mailing addresses are accurate.

Please note:  You must bring your own Factor and Medications to camp.  You do not have to bring infusion supplies like needles and syringes (Exception: Specialty port supplies will need to be provided by camper).  Also, bring any braces, supportive wraps, canes or other medical equipment you use.  ALL MEDICATIONS & INFUSION SUPPLIES BROUGHT TO CAMP WILL BE KEPT IN THE INFIRMARY.

IMMUNIZATIONS

Attach a copy of your immunization record or check box that record will be sent before camp. You MUST also provide proof of tetanus immunizations.

This form is confidential and used solely by the Infirmary Staff to meet your medical needs while at camp.  If you have questions please call our Health Director, Kyme Groller at (907) 917-9235 or email kyme.groller@akbdc.org

Authorization and Acknowledgments

 Camp Frozen Chosen (“CFC”) is operated by the Alaska Hemophilia Association (“AHA”) to serve and support the Alaska bleeding disorder community.  By signing this waiver and consent, I, the legal parent/guardian grant permission for myself/my children to attend CFC and participate in any and all “Camp Activities” including but not limited to transport to and from camp provided by AHA, climbing/hiking/trekking, camping, lifeguard supervised-swimming, boating, fishing, archery, rock climbing wall, and rope challenge courses unless otherwise specified on the Family Medical Form or Camper Medical Form.  I recognize and acknowledge the inherent risks that these Camp Activities may present for me/my children, and I assume and accept full responsibility for myself and my children for all such risks, including risks related to negligence of third parties and of AHA and CFC staff.

I acknowledge that the possession of use of alcoholic beverages and illegal drugs are strictly forbidden. I understand the possession of any weapon (firearm, knife, explosives, etc.) is strictly forbidden on camp property.

I authorize AHA to release my demographic information to supporting affiliates who help with the cost of my child attending camp.

I acknowledge no family animals/pets will be allowed on the premises of CFC with the exception of service dogs.

Medical Consent

AHA will make every effort to contact those specified in the contact information forms in the case of an emergency. I hereby authorize any and all medical treatment deemed necessary for me and my children by AHA and CFC staff while participating in CFC and Camp Activities, and give permission for AHA and CFC medical staff to administer any medications needed and to provide and arrange for any necessary medical treatment to myself/my children while at CFC, including onsite and offsite emergency care. I accept responsibility for the costs of all such medical treatment.  I further agree that, in the event that AHA deems it necessary to administer, or have administered, emergency first aid or CPR, to remove and/or evacuate me and/or my children from CFC, or to seek emergency medical care for me and/or my children that I am giving AHA and CFC Staff permission to administer or have administered emergency first aid or CPR, secure emergency transport or medical care, and/or disclose any medical information it may have about me/my children to any health care provider which may become involved in the care, treatment, or removal from CFC. By signing this document, I am waiving any right to object to or bring any type of action or claim against AHA and CFC Staff for its administration of, or having administered, emergency first aid or CPR, or for securing emergency transport or medical care and/or for the disclosure of personal medical information it may have about me to any health related person who becomes involved in my/my children’s care or removal from CFC.  I further certify that I have adequate and appropriate insurance to cover all costs associated with any injury, damage, or emergency transportation I and/or my children may cause or incur while participating in the Activity, or in its absence, I agree to bear all costs associated with such injury, damage, or emergency transportation myself, and to indemnify AHA for all such related expenses, including transport and treatment costs.  

Participation Release and Waiver

 Because I acknowledge, understand, and accept the risks of attending myself or allowing my children to participate, I hereby voluntarily release, forever discharge, and agree to indemnify and hold harmless CFC AHA and its trustees, directors, officers, employees, agents, affiliates, volunteers, and CFC medical staff from any and all damages, claims, demands, lawsuits, causes of action, and liabilities of any nature which in any way arise out of or relate to my or my children’s participation in CFC and Camp Activities and/or my or my children’s use of AHA and CFC equipment or facilities, including any such claims which allege negligent acts or omissions of AHA and CFC Staff whether related or unrelated to the inherent risks set forth herein.

 Participation in Medical Infusion Education

 Because I acknowledge the risks of attending myself or allowing my children to participate, I agree to release and hold harmless CFC and its founder, trustees, directors, officers, employees, agent, affiliates, volunteers and medical staff (“Staff”) from any and all injury claims of any other nature which may result from my/my children’s participation in education regarding self-infusion or infusion support skills.  I agree to indemnify and hold CFC, its Staff and other children at CFC harmless from any and all liability cause by myself/my children, whether or not intentional.

 Photography/Video/Digital Media Release

In consideration of my/my children’s participation at CFC, and without any further consideration from CFC, I hereby grant permission to CFC and Staff to utilize my appearance, performance or voice in any and all manner and media throughout the world for the purpose of promoting, reporting or publicizing CFC. Camp Frozen Chosen may use my/my children’s first name, likeness, voice and biographical material in connection with publication, promotion, exhibition and distribution of such material. I understand that no royalty, fee or any other compensation of any kind shall become payable to me by reason of such release and use of any photograph or video or other digital media.

THIS RELEASE IS A BINDING AGREEMENT THAT PREVENTS YOU FROM BRINGING A LAWSUIT AGAINST THE RELEASED PARTIES.  PLEASE READ IT CAREFULLY BEFORE PROCEEDING. YOU ARE GIVING UP ALL YOUR RIGHTS (AND THE RIGHTS OF YOUR HEIRS, ASSIGNS, AND ESTATE) TO BRING LAWSUITS OR MAKE CLAIMS AGAINST THE RELEASED PARTIES. 

 I HAVE READ THE FOREGOING ACKNOLWEDGEMENT OF RISKS, ASSUMPTION OF RISK AND RESPONSIBILITY, AND RELEASE OF LIABILITY AND UNDERSTANDING ALL THE ABOVE, I AGREE TO THE TERMS OF THIS RELEASE.

Parent/Guardian must sign. Signature represents legal authority for child listed above.

If you have any questions, you may contact Alaska Hemophilia Association at (907) 343-9232.

We are glad you have chosen to attend Camp Frozen Chozen this year! Camp life offers many unique opportunities and experiences for you and your fellow campers. We hope you make new friends, learn a lot, and have a great time!

At Camp Frozen Chozen we expect campers to encourage, support, and show respect toward one another. Each person at camp has a responsibility to make camp life positive and enjoyable. We expect all campers to follow the behavior expectations outlined below.

BEHAVIOR EXPECTATIONS

1. I understand that everyone at Camp Frozen Chozen needs to be treated with respect and I need to show respect for others personal belongings, privacy and feelings. Any inappropriate touching between campers or counselors is not allowed. I understand that I can be sent home for this reason.
2. I understand that it is against camp rules to be involved with smoking, alcohol use, illegal drugs, weapons, vandalism, theft or any other illegal behavior. I know and understand that I will be sent home if I have brought any of these items to camp or use them.
3. Camp Frozen Chozen does not allow the use of knives (including pocketknives), guns or weapons of any kind and I promise to keep this rule.
4. I understand that it is against camp rules to leave camp unless I am on a special escorted approved camp activity or for a medical emergency that requires transportation to an outside medical facility.
5. I understand that I need to respect the camp facility and its equipment. I understand that my parents and I will have to pay for any damage I intentionally cause.
6. I understand that I have to sleep in my assigned cabin each night. I understand it is against camp rules to "sneak out" of my cabin after curfew and that I can be sent home for this behavior.
7. I understand that at any time if any staff member or another camper feels that I am a danger to myself or anyone else because of my behavior or something that I have said I will be required to talk to the social worker. I understand that I can be sent home if Camp Frozen Chozen staff feels that it is necessary for my safety or the safety of others.
8. If I have any problems at camp, I know and understand that I can go to my counselor, social worker, camp director, or any of the nurses or doctors at camp.
9. I understand that Camp Frozen Chozen has an anti-bullying policy and will not tolerate bullying in any manner whether verbal, physical or cyber. I further understand that I can be sent home if I am bullying other campers. Examples of bullying include but not limited to name calling, kicking, hitting, teasing or gossiping about another person, putting other kids down or posting mean and hurtful things on social media or electronic communication.

CONSEQUENCES

1. Depending on the severity (how bad) the situation is one or more of the following consequences will be taken.
2. I understand that my camp counselor or the camp social worker will discuss the behavior with me.
3. I may be given a "time out" or not allowed to participate in an upcoming activity.
4. The camp director or designated personnel may call my parents and discuss the behavior with them.
5. Depending on the severity (how bad) of the situation I may have to sit down with the camp social worker and or counselor to come up with my own personal behavior contract.
6. I understand that I can be sent home immediately and possibly not be allowed to return to Camp Frozen Chozen with or without a behavior plan in place even if it is my first time not following any of the behavior expectations.
7. I understand that if I am sent home for any reason my parents will be responsible for coming to pick me up at camp. This will be at my parent s expense. They will not be reimbursed for travel time, time taken off work, gas etc.
8. I have read and understand the Camp HONOR Behavior Expectations and have read, understand and agree to the consequences.