Counselor Kids for a Cure Camp 2026

Kids for a Cure Camp

Counselor Application
1. Camp Counselor Expectations

We are looking for enthusiastic, responsible, and engaged teen counselors who are ready to create a positive and fun camp experience for younger campers. As a camp counselor, you will play a vital role in ensuring the smooth operation of daily activities and maintaining a positive atmosphere. Below are the key expectations for this role:
- Be Engaged with Campers: You will be a role model for younger kids, so maintaining a positive attitude and showing enthusiasm for activities is key.
- Activity Leadership: You will help lead and supervise games, arts and crafts, and other camp activities, making sure all kids are participating and having fun.
- Mentoring: You’ll be guiding and helping campers in both structured and unstructured activities, providing support, guidance, and positive feedback.
- Assist with Camp Operations: Helping the camp staff prepare for the day’s activities is important. You will assist in setting up areas for games, arts, crafts, or meals, and helping with cleaning up after activities.
- Teamwork with Staff: You will support staff with tasks such as maintaining camp areas, and any other duties that help ensure the smooth running of the day-to-day activities.
- Stay Present & Limit Phone Use: While we understand that phones are part of everyday life and diabetes management, it is important to keep phone use to a minimum during camp hours. Phones should only be used during breaks or designated free time and never during activities or when interacting with campers. Your focus should be on engaging with the campers and being present in the moment.
- Role Model Behavior: As a counselor, you are setting an example. The kids will be watching you, and it’s important to demonstrate appropriate behavior, focus, and attention.
- Show Responsibility and Leadership: Always prioritize the safety and well-being of the campers. Be attentive to their needs, help manage any potential conflicts, and communicate effectively with other staff members.
- Leadership: This is a leadership role. You will be expected to show initiative, help others, and contribute to the team. Whether it’s coming up with activity ideas, stepping up when needed, or helping others when they’re overwhelmed, your leadership is crucial.
2. Requirements
- Age 15 and older
- Teacher’s written recommendation (if new to the KFCC camp)
- Documentation of previous experience with children (if new to KFCC camp)
- Responsible for diabetes self-management per guidelines provided
- Availability to help at camp on the following dates: June 22–26, 2026
2. Application Checklist: Complete and sign the following forms and return them with payment by March 31, 2026.
- Health and Emergency Authorization
- Health History Information
- Release of Liability and Assumption of Risk
- Pool Day Form
- Consent to Photograph/Interview and Release of Liability
3. Register online or mail to:
Kids for a Cure Club
c/o MWH Diabetes Management, Katie McGuigan
4710 Spotsylvania Parkway, Ste. 200
Fredericksburg, VA 22407

IMPORTANT DATES:

Camp Orientation & Parent Meeting: Thursday June 4, 6–7 p.m.

Camp Decoration (if available): Sunday, June 21, 2–5 p.m.

Camp: Monday June 22–Friday June 26, 9 a.m.–2:30 p.m. Counselors will be asked to arrive earlier.

Closing Ceremony for family and friends & wrap up: Friday June 26, 1:30–2:30 p.m.

Questions: Call 540.741.2210 or email Stefanie Rekdal, Team Lead Stefanie.rekdal@mwhc.com
T-shirt size*
Counselor Name*

First NameLast Name
Parent/Guardian Signature (Guidelines)*

Clear
Date*

MonthDayYear
Date

Health and Emergency Authorization Form

This form is intended to assure that your child will be able to receive proper medical care should he/she require it, even if you are not available at the time of need. In an emergency, we will first attempt to reach a parent or guardian.
Date form completed*

MonthDayYear
Date
Date of last physical exam*

MonthDayYear
Date
Child's Name*

First NameLast Name
Height*
Weight*
Date of Birth*

MonthDayYear
Date
MaleFemale
Home Address*

Street Address

Street Address Line 2

CityState

Zip Code
Home Phone Number*
Please enter a valid phone number.
Parent's Phone Number*
Please enter a valid phone number.
Parent's Email*
example@example.com
Please provide TWO phone numbers/contacts that can be used in case of emergency during camp hours.
Contact 1*

First NameLast Name
Contact 1 Phone Number*
Please enter a valid phone number.
Contact 1 Relationship to Child*
Contact 2*

First NameLast Name
Contact 2 Phone Number*
Please enter a valid phone number.
Contact 2 Relationship to Child*
Child’s Endocrinologist

First NameLast Name
Endocrinologist phone number*
Please enter a valid phone number.
Child’s Primary Care Physician*

First NameLast Name
PCP phone number*
Please enter a valid phone number.
Insurance Company*
Insurance Identification or Policy #*
I/We, being the parent (s) or legal guardian (s) of the above-named minor, do hereby appoint Mary Washington Healthcare personnel (e.g. program manager, camp nurse, etc.) to act on my/our behalf in authorizing emergency medical, dental, or surgical care and hospitalization for the above minor during the period(s) of my/our absence.
Parent/Guardian 1*

First NameLast Name
Relationship to child*
Parent Signature 1*

Clear
Parent/Guardian 2

First NameLast Name
Relationship to child
Parent signature 2

Clear

Release of Liability and Assumption of Risk

Please read this form carefully and be aware that by signing and participating in this program you will be assuming the risk and legal liability and waiving and releasing all claims for injuries, damages or loss which you or your minor child/ward might sustain as a result of participating in any and all activities connected with and associated with this program, including transportation services to and from Kids for a Cure Day Camp.

I recognize and acknowledge that there are certain risks of physical injury to participants in the Kids for a Cure Day Camp, and I voluntarily agree to assume the full risk of any and all injuries, damages or loss, regardless of severity, that my minor child/ward or I may sustain as a result of participating in any and all activities connected with or associated with Kids for a Cure Day Camp.

I further agree to waive and relinquish all claims I or my minor/ward may have (or accrue to me or my child/ward) as a result of participating in any program/activity against Kids for a Cure Day Camp including its owner, participants, agents, volunteers, and employees.

I do hereby fully release and forever discharge Kids for a Cure Day Camp from any and all claims or injuries, damages, or loss that my minor child/ward or I may have, or which may accrue to me or my minor child/ward and arising out of, connected with, or in any way associated with Kids for a Cure Day Camp.

I have read and fully understand the above important information, warning of risk, assumption of risk, and waiver and release of all claims.
Counselor Name*

First NameLast Name
Counselor DOB*

MonthDayYear
Date
Date*

MonthDayYear
Date
Parent's Signature*

Clear

Pool Day

Each child will be assigned to a counselor and an adult for supervision. Pick up will be at the pool this day. More details will follow.
Please check the response that best describes your child’s swimming ability:*

I have good swimming skills and am comfortable in the water.I am a fair or a non-swimmer and need to stay in water that is no more than chest deepI cannot swim and need to stay in the shallow end of the pool
Additional comments:
Counselor's Name*

First NameLast Name
DOB*

MonthDayYear
Date
Date*

MonthDayYear
Date

Consent to Photograph and Interview
I First Name* Last Name* consent to having photographic, video, electronic, audio media or interview conducted of myself, my child, or for the person(s) for whom I am responsible (name(s): First Name* Last Name* .)
I consent / decline (choose one) that my first name, the first name of my child(ren) and/or the person(s) for whom I am responsible be shared for the use in the publication, education or audio-visual program listed above.*

ConsentDecline
I consent / decline (choose one) to having friends, family and/or the caregiver interviewed regarding my condition, the condition of my child(ren), and/or the condition of the person(s) for whom I am responsible.*

ConsentDecline
I consent / decline (choose one) to having general information regarding my condition, the condition of my child(ren), and/or person(s) for whom I am responsible released by a Mary Washington Healthcare spokesperson, and if applicable, to law enforcement personnel conducting official investigations.*

ConsentDecline
I consent / decline (choose one) to having general information regarding my condition, the condition of my child(ren), and/or person(s) for whom I am responsible released by a Mary Washington Healthcare spokesperson, and if applicable, to law enforcement personnel conducting official investigations.*

ConsentDecline
I hereby release Mary Washington Healthcare, its subsidiaries, its personnel, my friends, family, caregiver and any persons participating in my care, the care of my child(ren) or the care of the person(s) for whom I am responsible from any and all liability that may or could result from the taking or the use of this media, release of general information by a Mary Washington Healthcare spokesperson and release of information to law enforcement personnel.*

Clear
Note: If the above patient is an unemancipated minor (under the age of 18), the above consent is given on the patient’s behalf by:*

Clear
Witness*

Clear
Date*

MonthDayYear
Date
Should be Empty:

Kids for a Cure Camp

Health and Emergency Authorization Form

Health History

Allergies

Release of Liability and Assumption of Risk

Pool Day

Consent to Photograph and Interview