2026 Camper Application

Camper Application

July 6 - 10, 2026
Campers must be seven (7) years old before July 6, 2026 and not more than fifteen (15) 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. Please complete as much of the application as possible before contacting your treatment center. 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 11 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.

If you are unable to finish this application, please be sure to click on the "save" button to receive a link to get back into the application where you left off.

**Your child will receive a COVID screening, and if positive, they will receive a COVID test before boarding the bus or moving forward with check-in. Please assure your child is symptom-free when sending them to camp.**
Camper's Information
Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Age at time of Camp*
T-shirt Size*
What grade are they entering?*
Ethnicity*
YesNo

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 camper*
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
CAMPERS WILL BE REQUIRED TO TAKE A COVID TEST PRIOR TO GETTING ON THE BUS TO CAMP OR IF BEING DROPPED OFF ONE WILL BE GIVEN UPON ARRIVAL AT BRANDON SPRINGS.
Memphis BusNashville BusKnoxville BusWill be dropped off by car
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 BusWill be picked up by car
Name of person picking you up from camp*

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

MEDICAL HISTORY
MaleFemaleOther
Height*
Weight*
YesNo

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:

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 of application.
Cancelof

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

PERSONAL BEHAVIOR CONTRACT

We are glad you have chosen to attend Camp Freedom this year! Camp life offers many unique opportunities and experiences for you and your fellow campers. We hope you make new friends, learn a lot, and have a great time! At Camp Freedom we expect campers and volunteers to encourage, support, and show respect toward one another. Each person at camp has a responsibility to make camp life positive and enjoyable. We expect all campers to follow the behavior expectations outlined below.
Behavior Expectations

1. Campers will treat everyone in the camp community with respect at all times and show respect for others' personal belongings, privacy, and feelings.

2. Campers will remain with their counselors, follow directions, and abide by camp rules.

3. Campers will not be involved with smoking, alcohol use, illegal drugs, weapons, vandalism, theft, or any other illegal behavior.

4. Campers will use appropriate language; profanity will not be tolerated.

5. Campers will be expected to find a trusted adult (counselor, staff person, or social worker) to talk to if he or she becomes very upset to avoid acting out in a negative way.

6. Campers will remain in camp unless on an escorted approved camp activity or for a medical emergency that requires transportation to an outside medical facility.

7. Campers will respect the camp facility and its equipment. Campers will be responsible for all damage due to negligence or intentional vandalism.

8. Campers will be required to participate in a swim evaluation (1. Swimming: jumping into pool, swim side-to-side, then lift themselves back onto pool deck. 2. Treading water. 3. Demonstarte the ability to float) this iwll determine their currect level/rating for pool activities. Once a swimmer is evaluated, he or she can request to be retested with the Aquatics Director at a scheduled time to advance his/her current rating/level of pool activities.

9. Campers will sleep in their assigned cabins/bunks each night.

Consequences

If a camper chooses not to follow the previously listed behavioral expectations, the following consequesces may be issued depending on the severity of the situation.

1. Counselors will discuss the behavior with the camper.

2. Camper will be given a "time out" or not allowed to participate in a subsequent activity.

3. Camp Director/ Camp Social Worker will be notified and address the behavior with the camper.

4. Parent/Guardian will be contacted by the child and/or Camper Diector/Camp Social Worker to discuss behavior. The child's HTC Social Worker may be contacted to be informed of behavior at camp.

5. Camper will be dismissed from camp. Parent/Guardian will be responsible for picking up the camper.

I have read and understand the Camp Freedom Personal Behavior Contract and have discussed it with my child. I agree to support the behaviors and consequences listed above. If it is determined that my child must be dismissed from camp, I understand that I will be required to pick him/her up from the camp facility.
Camper Signature

Clear
Parent/Guardian Signature

Clear
Date

MonthDayYear
Date
Should be Empty:

Camper Application

Camper's Information

Contact Information

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

Transportation

MEDICAL HISTORY

BLEEDING DISORDER HISTORY

Treatment Protocol

ADDITIONAL MEDICAL HISTORY

Insurance Information

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

Behavioral

Parental Consent and Waiver

PERSONAL BEHAVIOR CONTRACT