2026 LIT Application

LIT Application

July 5 - 10, 2026
Campers must be sixteen (16) years old before July 5, 2026 and not more than seventeen (17) years old on July 10, 2026.

You are responsible for contacting your child's Hemophilia Treatment Center or physician to get the healthcare provider form signed and then uploaded. All campers must also include a complete copy of their immunization record with the application and a copy of both sides of their insurance card.

For your application to be accepted YOU MUST:

1. Complete the entire application before the deadline of June 15th.

2. Have the Healthcare Provider Form on Page 12 completed and signed by your Hemophilia Treatment center. Your primary care physician can complete this if your child does not have a bleeding disorder.

3. Must be up to date on all immunizations required for school attendance by the TN Department of Health. If you have questions regarding immunizations, please reach out to the foundation as soon as possible to avoid potential issues with your child attending camp.

**LIT's will receive a COVID screening, and if positive, will receive a COVID test before joining other camp LIT's or 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*
What grade are you entering?*
Ethnicity*
Cell Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
YesNo

Camp Freedom LIT Guidelines
- Camp Freedom is a nut free facility. Food containing nuts or made in a facility that processes food with nuts will not be allowed on the grounds or buses due to nut allergies
- Actively participate in staff training and activities
- Set a good example for the children and reward and encourage their good behavior with attention and affection
- Keep a positive attitude. try to work out problems with LIT Program Coordinator / Camp Freedom staff
- Be sensitive to the LIT members' needs
- Be aware of camp and pool rules
- Help maintain a safe environment by letting leadership staff know of any potential problems or behavioral issues
- Find ways to assist other LIT's / staff and always feel comfortable asking questions
- Wear proper clothing for camp and its activities. PLEASE BRING A WATCH!!
- Treat this experience like you would a job
- If you have a cell phone keep it out of sight and in a secure location
- Report to all camp events and meals on time! ONCE AGAIN, YOU WILL NEED TO BRING A WATCH!!
- Be prepared to receive feedback from anyone at camp
- Develop skills in planning and implementing activities with children
- Stay until the job is done, this means clean up as well. All LIT's will be dismissed at the same time at the end of the camp session when the buses leave
My signature below indicates that I have read the above camp guidelines and agree to abide by them while volunteering at Camp Freedom.
Signature*

Clear
Date*

MonthDayYear
Date

Contact Information
Parent or Guardian Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Cell Number*
Please enter a valid phone number.Format: (000) 000-0000.
Secondary Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
Emergency Contact (This needs to be someone living outside of the home.)

In case of emergency, if the parent/guardian cannot be reached, please contact:
Name*

First NameLast Name
Relationship to LIT*
Cell Phone*
Please enter a valid phone number.Format: (000) 000-0000.
Secondary Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
* If you have a change of address, phone number, or emergency contact, please call the THBDF office so it can be changed on your application. All confirmation information will me emailed to the email address on your application.

Transportation

You will need to arrive at camp a day earlier than the campers. Please let us know who will be dropping you off.
Name of person dropping you off at camp*

First NameLast Name
Phone number of person dropping you off*
Please enter a valid phone number.Format: (000) 000-0000.
Memphis BusNashville BusKnoxville BusSomeone is picking you up
Name*

First NameLast Name
Cell Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.

MEDICAL HISTORY
Name*

First NameLast Name
Date of Birth*

MonthDayYear
MaleFemaleOther
Height*
Weight*
YesNo

Pediatrician's Name*

First NameLast Name
Pediatrician's Phone Number (Daytime Hours)*
Please enter a valid phone number.Format: (000) 000-0000.
Pediatrician's Phone Number (After Hours)*
Please enter a valid phone number.Format: (000) 000-0000.

Insurance Information
TennCareMedicaidPrivate Medical InsuranceNo Medical InsuranceOther
Policy #*
Group#*
Policy Holders Name*
YesNo
Pre-certification phone number*
Please enter a valid phone number.Format: (000) 000-0000.
**Please upload a copy of your insurance card (front and back)**
Insurance card upload (front and back):

This is required but can be added after submission of application.
Cancelof

Please list all medications (Factor and Over The Counter) you will be bringing to camp and ALL factor dosing instructions below

Your child must bring ALL medications that will be needed for the entire week of camp.

Medication List

Rows	Medication Name	Strength	Dosage	Times of Administration	Purpose of Medication
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.

YesNo
List other medical conditions*
YesNo
Please list hospitalizations / surgeries and dates below*

Please send to your HTC / Hematologist or Pediatrician to fill out.
Upload completed form from doctor

This is required but can be added after submission.
Cancelof

Leadership Training Program Questionnaire
Why are you interested in becoming a Leader in Training or returning to Camp Freedom as a LIT?*
If you have been a camper in the past (at any camp), how do you think the LIT role will be different from being a camper? If you have been an LIT before, what is the most rewarding part and the most challenging paring of being an LIT?*
List three (3) of your strengths that will help you as an LIT.*
Can you think of anything that may prevent you from fulfilling your LIT responsibilities at camp? If yes, explain.*
List three (3) goals you have once you graduate from high school.*
What are some organizations or activities in which you are involved?*
If you have a bleeding disorder: What effect has your bleeding disorder had on your life?
If you do not have a bleeding disorder: What is your connection to the bleeding disorders community? What interests you in working with the bleeding disorders community as an LIT at Camp Freedom? Do you know someone who has a bleeding disorders or other chronic medical condition?
Describe a time in your life where you went above and beyond to help someone.*
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
MineParent/GuardianOther
Email*
example@example.com
MineParent/GuardianOther
You will be contacted for an interview as part of the LIT selection process. Please list the best phone number and email address to contact you to set up the interview.

Parental Consent and Waiver

Have your parent or guardian read over this page and sign.
THIS AUTHORIZATION, ACKNOWLEDGMENT AND RELEASE ARE GIVEN IN FAVOR OF CAMP FREEDOM AT BRANDON SPRINGS GROUP CENTER IN DOVER, TN, AND THE TENNESSEE HEMOPHILIA AND BLEEDING DISORDERS FOUNDATION, FROM NOW ON REFERRED TO AS "RELEASED PARTY".

By signing this Authorization, Acknowledgement and Relase I, the legal parent/guardian grant permission for my child, {name}, to participate in any and all activities including but not limited to Lifeguard supervised swimming, Lifeguard supervised kayaking/canoeing and fishing under the supervision of certified instructors at Camp Freedom unless specified otherwise on the Camp Freedom Medical Form. I recognize and acknowledge the inherent risks, including severe bodily injury and death that these activities may present for my child.
MEDICAL CONSENT

The released Party will make every effort to contact me in the case of an emergency. I give my permission for the Released Party and their medical staff to administer medication and to provide for, arrange for and authorize any and all necessary medical treatment for my child while at Camp Freedom, including onsite and offsite emergency care. I understand that I will be responsible for the costs of all such medical treatment and hereby agree to indemnify and hold the Release Party harmless for any charges for medical treatment for my child.
PSYCHOSOCIAL CONSENT

Camp Freedom strives to provide a safe physical environment AND a safe emotional environment for each and every camper. I give my permission for the Social Worker at Camp Freedom to speak with the Social Worker at my child's Hemophilia Treatment Center for the purpose of discussing any psychosocial issues that may impact my child at camp. I also understand that the Camp Freedom Social Worker may contact me directly to discuss any concerns that arise at camp. I can be reached at the following phone number.
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.
PARTICIPATION RELEASE AND WAIVER AND HOLD HARMLESS AGREEMENT

Because I acknowledge the inherent risks of allowing my child to participate in activities at Camp Freedom, for myself and my child, I hereby release, acquit, and forever discharge the Release Party and their directors, officers, employees, agents, volunteers, and medical staff and all other persons who might be liable from any and all claims, damages, injuries, tort liability and all other liabilities of every nature whatsoever resulting from the negligence or other acts of the Released Party, and their directors, officers, employees, agents, volunteers, and medical staff and other children at Camp Freedom harmless from any and all damages caused by my child, whether or not intentional and to indemnify the Released Party for any damages suffered by them due to the acts of my child.
PHOTOGRAPHY RELEASE

In coordination with my child's participation at Camp Freedom, and without any further consideration from the Released Party, I hereby grant permission to the Release Party to utilize my appearance, performance, or voice, and my child's appearance, performance, or voice in any and all manner and media throughout the world for the purpose of promoting, reporting or publicizing the Tennessee Hemophilia and Bleeding Disorders Foundation. The Released Party may use my and my child's name, likeness, voice, and biographical material in connection with the publication, promotion, exhibition, and distribution of such materials. I understand that no royalty, fee, or any other compensation of any kind shall become payable to me by reason of such release and use of my or my child's appearance, performance, or voice.

Please contact the Tennessee Hemophilia and Bleeding Disorders Foundation if you have any questions before signing. The number is 615-900-1486.
I HAVE READ THIS FORM CAREFULLY.

I UNDERSTAND AND ACKNOWLEDGE THAT I AM SIGNING A LEGAL DOCUMENT ON BEHALF OF MY CHILD AND TO CONSENT ON BEHALF OF MY CHILD.

I HAVE THE LEGAL AUTHORITY TO EXECUTE THIS DOCUMENT ON BEHALF OF MY CHILD AND TO CONSENT ON BEHALF OF MY CHILD.

I HAVE BEEN AFFORDED THE NECESSARY OPPORTUNITY TO ASK QUESTIONS AND SEEK ADVICE AND COUNSEL REGARDING THE TERMS OF THIS DOCUMENT BEFORE SIGNING.
Child's Full Name*

First NameLast Name
PARENT / GUARDIAN MUST SIGN. SIGNATURE REPRESENTS LEGAL AUTHORITY FOR CHILD LISTED ABOVE.
Parent/Guardian Name:*

First NameLast Name
Signature*

Clear
Date*

MonthDayYear
Date
Should be Empty:

LIT Application

Camp Freedom LIT Guidelines

Contact Information

Emergency Contact (This needs to be someone living outside of the home.)

Transportation

Bleeding Disorder History

Treatment Protocol

Medical History Continued

Insurance Information

Please list all medications (Factor and Over The Counter) you will be bringing to camp and ALL factor dosing instructions below

Leadership Training Program Questionnaire

Parental Consent and Waiver