Camp Kidney 2022 Camper Registration

Camp Kidney 2025 Volunteer Application
WELCOME TO CAMP KIDNEY 2025

Camp Kidney will be held from Friday, October 24th through Sunday, October 26th at Camp Pinerock in Prescott, Arizona. Volunteers must be available/must commit to the entire weekend. Arrival on Friday, October 24th must be prior to our campers arrival at 2pm. We ask that all volunteers arrive at 10am. Departure on Sunday, October 26th will be after campers depart roughly around 1pm.

Below is the 2025 Camp Kidney Volunteer Application. You must submit the enclosed application by Monday, September 29, 2025. Late applications will not be accepted.

Thank you for giving your time and for being a part of the magic of Camp Kidney.
Pre-Camp Meeting:

Date & Location: Saturday, October 18th

Location: NKFAZ Office (360 E. Coronado Road, Phoenix 85004)

10am - Campers & Families

11:00am - Staff/Volunteers/Med Team

11:45am - CPR training (optional)

We ask that all counselors/programming team/med team attend the Camper/Family meeting too.

After the camper meeting, we will be meeting as a team for a more indepth discussion of the schedule/activities of camp as well as any camper notes from our Med Team.

We will also be providing CPR training for all volunteers who are interested in receiving training.

Please let us know if advance if you are not able to attend this meeting. This meeting is not mandatory but incredibly helpful prior to camp.

All volunteers must be over the age of 21. Please note that we do not allow any parents/guardians or siblings of campers to apply/attend camp as a volunteer.

We look forward to seeing you to Camp Kidney 2025!
Volunteer Name:*

First NameLast Name
Birth Date:*

MonthDayYear
Gender*

FemaleMale
Mobile Phone Number:*

Area CodePhone Number
Secondary Mobile Number:

Area CodePhone Number
Email Address:*
Emergency Contact:*

First NameLast Name
Emergency Contact Phone Number*

Area CodePhone Number
Primary Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Secondary Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Upload Copy of Driver's License *

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Medical Insurance Company
Policy Number
Upload Insurance Card Photo *

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Select Camp Sweatshirt size:*

SmallMediumLargeXLarge2XL
Select Camp Sweatpants size:*

SmallMediumLargeXLarge2XL
If we were able to also purchase long sleeve shirts, please let us know if you would like the same size or different from the hoodie size above. *
Please select the type of volunteering you wish to be part of:*

CounselorProgramming TeamMed Team
Are you a returning Camp Kidney Volunteer?

YesNo
As we have the most incredible volunteers, returning volunteers will have the first right of refusal for this year's Camp Kidney. This year we are looking for a total of 12 Counselors.
MEDICATION

For the safety of our campers, we ask that all volunteers provide information regarding their own medications and medical supplies. We also ask that all medications/supplies are kept out of access of all campers. Medications/supplies may be held with Med Team if preferred.

Medication Listing

	Medication Name	How much do you give with each dose? (ml or # of pills)	What time do you give the medication?
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.

Please list any medications not listed above.
Medical Questions
Allergies*

NONEMedicationsFoodsInsect/Bee StingsLiquids/Drinks and FoodOther
If yes, please provide details:
Please provide information regarding symptoms and treatment for known allergies.
CPR Certified

YesNo
If yes, please include date of certification.
Medical Supplies
List ANY & ALL supplies (e.g.; inhaler, epipen, etc) you will need/could need at camp- enough for 3 days and 2 nights.

Supplies List

	Supply	Used For	Special Instructions
1
2
3
4
5
6
6
7
8
9
10

IMPORTANT:

Please know that YOU will be responsible to provide all medical equipment, medications and supplies for camp. Be sure to pack enough of everything to last 3 days and 2 nights at camp.
Please include any other medical information you feel the Med Team should be aware of.
Vaccination Policy & Updates

.
Due to the nature of our camper population, many of whom are immunocompromised, we ask that you help us in ensuring that Camp Kidney is a safe space for these campers by:

1. With the increase of Measles outbreaks around the United States, all volunteers MUST have received the MMR (Measles, Mumps & Rubella) vaccination.

Vaccination reccords can be obtained from your former peditrician's office or if you are an Arizona native, online at the Arizona Deptarment of Health Services https://irr.azdhs.gov/irr-form.php . Most states also have an online form to receive older immunization reccords.

If you are unable to obtain your reccords, a titer (blood draw/test) may be performed. NKF will pay for the lab costs. Please reach out to Ashleigh directly to schedule this.

2. Due to the nature of our camper population,Covid-19 vaccination including the recent booster is encouraged for your protection, but not required. Masking is optional, and welcome.

3. All Counselors/volunteers MUST receive the 2025/2026 Flu Vaccine prior to attending Camp Kidney. Please upload documentation below or email it directly to Ashleigh.

4. Any Camp Kidney participants experiencing cold or flu-like symptoms are encouraged to please refrain from attending Camp.

5. Due to the nature of our campers and their health and saftey, please complete the below section regarding Intigrated Tuberculosis (TB).

6. Reminder that Tetanus shots should be updated every 10 years.
Please sign acknowledging of the above.

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Please upload any immunization documents

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Integrated Tuberculosis (TB) Screening and Risk Assessment Form for Camp Kidney Volunteers
Have you EVER spent more than 30 days in a country with an elevated TB rate? This includes all countries except those in Western Europe, Northern Europe, Canada, Australia, and New Zealand.*

YES I have been in a foreign country for >30 days (not including those listed above)NO I have not been in any country for >30 days except the ones listed above
Have you had close contact with anyone who had active TB since your last TB test?*

YesNo
Do you currently have any of the following symptoms:
1. Unexplained fever for more than 3 weeks*
2. Cough for more than 3 weeks with sputum production*
3. Bloody sputum*
4. Unintended weight loss >10 pounds*
5. Drenching night sweats*
6. Unexplained fatigue for more than 3 weeks*
Have you ever been diagnosed with active TB disease?*

YesNo
Have you ever been diagnosed with latent TB infection or had a positive skin test or a positive blood test for TB?*

YES one or more of these is true for meNO none of these is true for me
Have you been treated with medication for TB or for a positive TB test (eg, taken “INH”)?*

YesNo
If YES, what year, with which medication, for how long, and did you complete the treatment course?
Do you have a weakened immune system for any reason including organ transplant, recent chemotherapy, poorly controlled diabetes, HIV infection, cancer, or treatment with steroids for more than 1 month, immune-suppressing medications such as a TNF-alpha antagonist or another immune-modulator? (If you are not sure, ask your primary care provider)*

YES, one or more of these is true for meNO, none of these is true for me

Conditions of Volunteering at Camp Kidney
1. Camp Kidney accepts no responsibility for the loss, damage, or theft of my property.

2. I understand that I will be covered solely by the medical insurance policy in which I am enrolled.

3. I authorize a licensed professional to dispense any medications recommended or prescribed by a physician during Camp Kidney.

4. I assume full responsibility for my safety. I agree to release and indemnify Camp Kidney, National Kidney Foundation of Arizona and all of their agents, representatives and employees (paid and volunteer) from any claims, costs, expenses and/or damages which I may sustain or incur.

5. If I have behaviors that are harmful to the camp community, I will be sent home. If I am asked to leave camp, it will be at my own expense. I acknowledge that I will be held financially responsible for acts of vandalism caused at Camp Kidney.

6. I agree to hold the professional staff of Camp Kidney, National Kidney Foundation of Arizona and all of their agents, representatives, employees and volunteers free from any liability which may arise from any accident or illness at Camp Kidney.
All of the above information is correct to the best of my knowledge.
Printed Name *

First NameLast Name
Signature*

Clear
Today's Date

MonthDayYear
Date
Emergency Medical Treatment
In the unfortunate case of medical and/or surgical emergencies, I authorize National Kidney Foundation of Arizona’s medical volunteers to render or arrange for the person named below to receive any x-rays, anesthetic, medical, dental, surgical procedure, treatment or medical care which is deemed advisable by and is to be rendered under the supervision of any physician, dentist, or surgeon licensed in the state of Arizona.
Printed Name *

First NameLast Name
Signature*

Clear
Today's Date

MonthDayYear
Date
Media Consent
I give permission to Camp Kidney, National Kidney Foundation of Arizona, Camp Pinerock, and other media invited to camp by Camp Kidney/National Kidney Foundation of Arizona to take and release video footage and photography of the person named below during his/her time at Camp Kidney.

I understand that any video or photo may be used on television, in newspapers, magazines, internet, or in any other medium that National Kidney Foundation of Arizona and Camp Pinerock may choose.
Printed Name *

First NameLast Name
Signature*

Clear
Today's Date

MonthDayYear
Date
Alcohol, Tobacco & Drug Policy
National Kidney Foundation of Arizona and Camp Pinerock Policy forbid the possession or use of any alcohol, tobacco, and/or un-prescribed drugs any time while at Camp Kidney.

Campers who don’t fully comply with this policy will be sent home immediately. In this instance, an authorized parent/guardian will be contacted and required to drive to Camp Kidney in Prescott, Arizona to pick up the camper. Staff and volunteers who don’t comply will also be sent home. No exceptions will be made.

Your signature below indicates your commitment to abide by this policy in its entirety. Please contact the National Kidney Foundation of Arizona at (602)840-1644 if you have any questions regarding this policy.
Printed Name *

First NameLast Name
Signature *

Clear
Today's Date

MonthDayYear
Date

Background Check
Under a policy determined by the NKF AZ Board of Directors, all volunteers must complete and pass a standard backgound check. Upon completion of this application, a background check form will be emailed you to directly. NKF AZ will cover all fees associated with the background check.

Background checks will be done yearly for every new Camp Kidney.

Please sign below that you acknowledge the policy and agree to the background check. Please reach out to NKF AZ directly with any questions or concerns regarding this policy.
Signature*

Clear

Thank you for volunteering at Camp Kidney.

We can't wait to see you in October.

Ashleigh & Jen

*If you were unable to upload any of the required documents, please email them directly to ashleighs@azkidney.org*
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Camp Kidney 2025 Volunteer Application

MEDICATION

Medical Questions

Medical Supplies

Vaccination Policy & Updates

Integrated Tuberculosis (TB) Screening and Risk Assessment Form for Camp Kidney Volunteers

Do you currently have any of the following symptoms:

Conditions of Volunteering at Camp Kidney

Emergency Medical Treatment

Media Consent

Alcohol, Tobacco & Drug Policy

Background Check