2026 Camp Youngblood Pre-Screening Survey

Enrolling parent/guardian: Fill out the short survey below to determine eligibility. Within one week of filling out you will receive an email from either VABDF/VHF or HACA, if you do not, please email Heather at heather@vahemophilia.org or call 804-740-8643. If you ARE eligible, the email will have a link to the full Camp Youngblood application and other important details.

In accordance with CHT’s Immunization Policy, all standard childhood immunizations are required. Given the population at CHT and for the safety of all campers, only medical exemptions with physician documentation and CHT Medical Director approval will be considered. Does your child meet this requirement?*

Yes, my child(ren) is fully immunized.My child(ren) has a documented medical exemption signed by a physician.Other

There will be a $50 non-refundable application fee per camper collected by CHT. This fee is charged after your application is complete, reviewed, and enrollment is confirmed by CHT via an enrollment email sent from CHT's Director of Programs, Caitlin Carroll. If this fee is a financial barrier, please emal info@vahemophilia.org or director@hacacares.org. Financial aid and payment plans are available. Do you acknowledge and agree to this fee policy?*

Yes, I understand and agree to the $50 per child non-refundable application fee.Other

Name (Parent/Guardian)*

First NameLast Name

Phone Number (Parent/Guardian)*

Please enter a valid phone number.

Email (Parent/Guardian)*

example@example.com

Name of camper #1*

First NameLast Name

Age of camper #1*

Do you have another camper to add?*

YesNo

Name of camper #2*

First NameLast Name

Age of camper #2*

Do you have another camper to add?*

YesNo

Name of camper #3*

First NameLast Name

Age of camper #3*

Do you have another camper to add?*

YesNo

Name of camper #4*

First NameLast Name

Age of camper #4*

Which bleeding disorders chapter are you affiliated with?*

Virginia Bleeding Disorders Foundation (VABDF) formerly Virginia Hemophilia Foundation (VHF)Hemophilia Association of the Capital Area (HACA)I am not affiliated with a bleeding disorders chapter

How did you hear about Camp Youngblood?*

Is this your camper's first year attending Camp Youngblood*

YesNoOther

Address (Parent/Guardian)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code