Clone of Teen River Camp 2025 Application

Teen River Camp Application 2026 - Initial Interest

Camp Dragonfly - partnering with the Hemophilia Association of San Diego County (HASDAC)
Teen River Camp (Monday, July 13 - Saturday, July 18, 2026)

Camper Applications will be closed after May 31, 2026.

Please fill out this application COMPLETELY.

Submitting this Teen River Camp application does not guarantee this camper a spot at camp. Space is limited, and attendance is dependent on all required forms being fully and accurately completed and submitted by May 31,2026.

Although it is recommended that you complete without saving, below are the instructions if you are interrupted during the process of filling out the form and need to save your spot.
- You can save your spot and come back to finish.
- Clicking 'SAVE' on the bottom of any page will open a window where users can sign up or log in using Google, Facebook, or email and save the session in their account's drafts folder.
- Users can also skip creating an account by clicking the 'Skip 'Create an Account'' link at the bottom of the window.
- Clicking the "skip" link will open a window where users can choose to copy the session link or have it sent to their email address.
Once application is accepted, you will need to provide the following information and documents:

Medical Information
- Teen River Camp-Physicians Camp Physical (form downloadable on nv.bleeding.org Teen Camp Information page) OR copy of letter from primary care physician (not the HTC) showing examination within 12 months of the first day of camp. Physician Forms must be completed and signed by the doctor
- A list of ALL medication (factor, other prescriptions, over-the-counter) that your camper takes
- A copy of the campers insurance card- both front and back
- A copy of the campers immunization records- signed and validated by the primary care physician.The following immunizations/vaccinations are required: DTap (Diphtheria/Tetanus/Pertussis), MMR (Measles/Mumps/Rubella), Measles, Varicella (chicken pox), Polio, Hepatitis A & B
Activity Waivers
- ETC Health and Waiver Form (downloadable on nv.bleeding.org Teen Camp Information page)
- Behavioral Agreement
TRANSPORTATION NOTE:

Southern Nevada Campers will be traveling via plane and van/car.

> Drop off in Las Vegas: depart from McCarran Airport in Las Vegas to travel to Reno-Tahoe Airport.

< Pick-up in Las Vegas: McCarran Airport, designated baggage carousel

Northern Nevada Campers: will be traveling via van/car.

> Drop off in Reno: depart from Reno-Tahoe Airport to take a shuttle bus to Lotus, CA for the ETC Base Camp.

< Pick-up in Reno: Reno-Tahoe Airport, designated spot TBD

More detailed travel information will be received once application has been approved.
Camper General Information
Camper's Full Name

First NameMiddle NameLast Name
a bleeding disorder patient (including carriers)an unaffected sibling of a bleeding disorder patient
Camper's Primary Spoken Language*
Date of Birth*
Age*
Entering School Grade*
(in the fall 2025/2026)
MaleFemaleNon-BinaryOther
T-Shirt Size
Please enter adult size
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Camper's Phone Number
Only used to be included in any camp team group textFormat: (000) 000-0000.
Camper's Email
Only used to be included in any camp team group email

Parent/Guardian Information

Primary
Parent/Guardian Primary Contact*

First NameLast Name
Parent/ Guardian's Primary Spoken Language*
Primary Address (if different from above)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Contact Home Phone

Area CodePhone Number
Primary Contact Cell Phone

Area CodePhone Number
Primary Contact Email*
example@example.com
Relationship to Camper*
YESNO

Parent/Guardian/Caregiver Information

Secondary Contact
Parent/Guardian Secondary Contact

First NameLast Name
Parent/ Guardian's Primary Spoken Language
Secondary Address (if different from above)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Secondary Contact Home Phone

Area CodePhone Number
Secondary Contact Cell Phone

Area CodePhone Number
Secondary Contact Email
example@example.com
Relationship to Camper

Emergency Contact Information

(Must supply at least two Emergency Contact's that are NOT a Parent/Guardian)
Emergency Contact #1 Name*

First NameLast Name
Relation to camper*
Phone Number*
(000) 000-000
Alternate Phone Number*
(000) 000-000
Emergency Contact #1 Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact #2 Name*

First NameLast Name
Relation to camper*
Main Phone Number*
(000) 000-000
Alternate Phone Number*
(000) 000-000
Emergency Contact #2 Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

By submitting this application, you and/or your teen are expressing that they are willing and able to attend our Teen River Camp in 2026.

By submitting this application, you and/or your teen commit to providing all required medical information and documentation a month before Camp so that the NV Chapter can book transportation logistics for your teen.

By submitting this application, you acknowledge that if your teen cannot attend Teen River Camp, you will notify the NV Chapter Team no later than one month before Camp. If you notify the NV Chapter Team within that one month before Camp, you may be responsible for reimbursing the Nevada Chapter for any travel expenses incurred on behalf of your teen.

After submission of this application, you will receive an email outlining all the additional information that will be required for your teen to participate in Teen River Camp.

We are very excited for your teen to have this incredible experience!
Should be Empty:

Teen River Camp Application 2026 - Initial Interest

Camper General Information

Parent/Guardian Information

Parent/Guardian/Caregiver Information

Emergency Contact Information

Bleeding Disorder Information