2026 Staff Application

Staff Application

July 5 - 8, 2026
**All staff will receive a COVID screening, and if positive, will receive a COVID test before joining other camp staff. Please assure you are symptom-free before coming to camp.**
Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Age at time of camp
T-shirt Size
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Preferred Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Secondary Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com

Do you use tobacco?
In most cases, a child must have previously attended Camp Freedom before their parent can participate as camp staff. Do you have children that will attend Camp Freedom 2026?
What are their ages and have they attended camp prior to 2026?
How did you hear about Camp Freedom?
Do you currently work for or do you anticipate you will work for a Hemophilia Specialty Provider or Hemophilia Product Manufacturer at the time of Camp Freedom 2026 (including part-time, PRN, or any type of consulting work or services)?
Is your supervisor aware that you plan to attend Camp Freedom 2026?
Please indicate Company name, Supervisor's name, and starting date of employment.

Full Legal Name

First NameMiddle NameLast Name
Social Security Number
State/Driver's License Number
Has your name ever appeared on a sex offender registry?
Have you ever been convicted of any crime except a minor traffic offense?
Has your driver's license ever been revokes or suspended?
Have you ever been fired for cause or suspended/expelled from school?
Applicant's Certification and Agreement

The facts set forth in my application are true and complete. I understand that if accepted, false statements on my application shall be considered sufficient cause for dismissal. You are hereby authorized to make any investigation on my personal history through any investigative agency or bureaus of your choice in compliance with applicable laws or statutes.

I understand that a volunteer placement at this organization is “at will” and includes no guarantee, contract or promise of employment for any specified length of time. I further understand that a criminal record check may be conducted on me, and I consent to any such check.

I understand that all applications are valid for 90 days and do not have to be kept in possession of The Tennessee Hemophilia & Bleeding Disorders Foundation past that duration.

I authorize the use of any information on this application and attached supplements to verify my statements, and I authorize the past employers, schools, all references and any persons or organizations, whether or not identified in this application, to answer any and all liability or damages on account of having furnished such information.
Signature
Date

MonthDayYear
Date

Education
High School (Name, City, Dates Attended, & Diploma or Degree)
College (Name, City, Dates Attended, & Diploma or Degree)
Grad/Other (Name, City, Dates Attended, & Diploma or Degree)
EMPLOYMENT HISTORY
Current (or last) Employer (Title & Supervisor's name)
Previous Employer (Title & Supervisor's name)
REFERENCES

Please list two people who can be contacted by email regarding your character and work habits. This may include only one former employer. Please do not list relatives.
Name

First NameLast Name
Occupation
Relationship
Email Address
example@example.com
Name

First NameLast Name
Occupation
Relationship
Email
example@example.com

CAMP EXPERIENCE
Do you have previous camp experience?
Have you volunteered at Camp Freedom within the last 5 years?
In a paragraph or two, tell us about your contributions in past years to the success of a THBDF program or event attended previously?
What are some ideas for improvement to the overall camp program and explain how you will help implement these changes in 2026?
Camp Experience #1 (if applicable)
Camp Name
Camp Director

First NameLast Name
Camp Director Email
example@example.com
Your position at camp
What date or year at this camp?
Camp Experience #2 (if applicable)
Camp Name
Camp Director

First NameLast Name
Camp Director Email
example@example.com
Your position at camp
What date or year at this camp?

MEDICAL HISTORY
Gender

Other
Weight?
Height?
Last Tetanus Booster/immunization
Please upload your Covid 19 vaccinations:

This is not required but please upload a copy if you have had this vaccination.
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Do you have a bleeding disorder?
What bleeding disorder?
What is your severity?
What factor do you use? (Please bring your own factor, supplies and medications needed for the week)
What is your treatment protocol:
What HTC or Hematologist do you see?
Contact name

First NameLast Name
Contact phone number
Please enter a valid phone number.Format: (000) 000-0000.
What HTC or Specialty Pharmacy do you get your factor from?
Contact name

First NameLast Name
Contact phone number
Please enter a valid phone number.Format: (000) 000-0000.
**Due to potential liability issues, ALL camp staff must have health insurance.**
Insurance Provider
Policy Number
Group Number
**Please upload a copy of your insurance card (front and back)**
Insurance card upload (front and back):

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Emergency Contact Person's Name

First NameLast Name
Emergency Contact's Relationship to you:
Emergency Contact's Cell Number
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact's Work or Home Number
Please enter a valid phone number.Format: (000) 000-0000.
Significant medical history (surgeries, serious injuries, hospitalizations, target joints?
Allergies?
Physical restrictions or limitations to activity:
Other important medical information:
MEDICAL RELEASE

In case of accident or illness, medical services may be provided by camp medical/nursing staff. In the event of an emergency and you cannot give consent for care, the medical center staff is authorized to carry out any necessary procedures. Staff members and volunteers assume financial responsibility for all medical expenses incurred while at camp. Medical insurance information is requested in the event referral of an injured or ill staff/volunteer becomes necessary.

I have read, understand, and agree with the above. I attest that I am physically fit for camp and no medical restrictions would prevent me from performing the essential functions of my job. I understand that the Tennessee Hemophilia & Bleeding Disorders Foundation assumes no responsibility for any preexisting injury or illness.
Signature
Date

MonthDayYear
Date

DRUG-FREE PLEDGE

I am aware that in compliance with Deferal Laws, any workplace where volunteer work is done for the Tennessee Hemophilia & Bleeding Disorders Foundation is considered a drug-free workplace, this includes recreational drugs and alcohol.

I understand that as a condition of volunteering at Camp Freedom, I am required to inform and agree to report any conviction for any drug-related offense. In addition, I pledge not to use any non-prescription drugs while at camp. All prescribed medicine will be secured in the infirmary.

Violation of this Federal Law will result in my expulsion immediately from summer camp.
Signature
Date

MonthDayYear
Date
AGREEMENT OF CONFIDENTIALITY

My signature on this agreement indicates my understanding that any Camper's/LIT's/Counselor's names or other confidential information I may receive while volunteering with the Tennessee Hemophilia & Bleeding Disorders Foundation's Camp Freedom will be treated as such by me.

I further agree that the names, addresses, telephone numbers, or any other information I may receive will not be used for any purpose beyond my volunteerism with the Tennessee Hemophilia & Bleeding Disorders Foundation. Under no circumstances will any information be used by me or given to any other person or to a representative of a company for the purpose of marketing or other contacts.
Signature
Date

MonthDayYear
Date
Should be Empty: