2026 Camp Youngblood Pre-Screening Survey

2026 Camp Youngblood Pre-Screening Survey

The Virginia Hemophilia Foundation (VHF), the Hemophilia Association of the Capital Area (HACA), and Camp Holiday Trails (CHT) are teaming up again for Camp Youngblood (CYB) in 2026!
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 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. (VHF and HACA will not be collecting this fee as in years past.)Your credit card will be charged after your application is complete, reviewed, and enrollment is confirmed.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.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 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
Should be Empty: