*CIT positions are available to all interested individuals ages 16 or 17 years of age*

This is an application process, applying for a CIT position does not guarantee the applicant will be selected.

A PARENT AND AN ADDITIONAL PERSON MUST BE AVAILIBLE FOR CONTACT 24 HOURS/DAY

If a second parent or legal guardian is not available, please list an alternate emergency contact, including name and phone number.

Bleeding Disorder Information
Instructions: Please send enough Factor concentrate for scheduled prophylaxis and extra emergency bleed doses. Campers who treat on-demand with factor MUST send emergency doses along with any other medicines that are a part of the treatment plan. Check expiration dates before sending meds to camp.

Instructions: Provide detailed information/Medication needs etc. to any boxes checked YES in the "Additional Information" box. If the condition requires medication, please list in MEDICATION SECTION. An HTC nurse may contact you before camp to discuss your medical needs.

Please make sure a copy of your immunization record gets uploaded with your PCP Medical Clearance Form (See below under Health Examination). Immunization documentation MUST be received prior to July 1st, 2026.

Please list all medications that will be taken during camp, include factor and any over-the-counter drugs. All medications, vitamins and dietary supplements will be kept in the Health Hut and records of use during camp will be maintained.

All medications must be labeled with YOUR FULL name

• Parent consent must be in writing (below).
• Prescription medication must be in its original container with a clear and accurate pharmacy label, which can be accepted as physician instructions. "Take as directed" or "as needed" is NOT specific and cannot be accepted as direction. You can request a duplicate medicine label from your pharmacy.
• If the directions on the bottle are different from what the physician is currently prescribing, written instruction is required from the physician.
• All medications (especially asthma inhalers/medications, Flonase, or Epipen) requiring a prescription from a doctor needs to be sent to camp with your camper.
• ALL medications must be un-expired. We cannot accept expired medications.
• If your child has a bleeding disorder, remember to bring an adequate supply of factor for prophylaxis and to treat any bleeding episodes. If your child has a mild bleeding disorder, he/she needs to bring one "life-saving" dose of factor to camp. Remember to bring Amicar/Tranexamic acid and Stimate, if responsive.
• Place all medication required at camp in a zip-loc bag labeled with your child's name. Carry the medication bag separately and give it directly to the health hut team. If the medication has been packed away, you will need to find it and give it to the nurse before your child gets on the camp bus or takes his or her bags to the cabin if being dropped off at camp.
• EXCEPTIONS: Children requiring inhalers or insect sting kits may keep those items with them; however, this consent form must be signed and the medication must be shown to the health hut team at the start of camp.
• At the end of camp the health hut team will return any left over medication to you. If you, or another adult assigned by you, does not pick up the medication when you pick up your child, it will be secured at the HTC for you to pick up at a later time.

CIT's with a bleeding disorder must have seen their Primary Care Provider (PCP) within the 12 months prior to camp. Download the medical clearance form below, have it completed and signed by your PCP, and upload the form once complete.

 

We will send you a Release of Information Form upon completion of your application to authorize the BDFW to work with your HTC to obtain the clinic notes from your last HTC appointment.

Thank you for your interest in applying to BDFWA Camp I-Vy. There is much anticipation for camp every year—by campers, their parents, and of course our dedicated staff. Developing a cohesive and engaged staff to set the tone of camp and create a positive environment is paramount. Please read the following Camp Mission and Counselor in Training (CIT) Program Objectives below and apply if you want to be an integral contributor to life-long memories for campers and staff alike.
Camp is physically and emotionally taxing, but with the concerted effort of a dedicated staff, camp is a joyful place, centered on children and focused on yielding positive outcomes for everyone involved.

Mission:

The BDFW Camp I-Vy Summer Camp seeks to inspire children within the bleeding disorders community to explore, learn, develop independence, make friends, and become their greater selves through a week of outrageously fun activities in a safe and secure resident camp environment.

CIT Program Objectives:

CITs are generally 16-17 years old. CITs must possess maturity, flexibility, a strong work ethic and the ability to have fun. The CIT program is intended to develop leadership skills that will be useful throughout the individual’s life. Identifying and achieving goals, improving communication and decision-making skills, learning responsibility and helping others are some of the main objectives for the CIT"s. In addition, we will teach these young people how to effectively lead children in any setting. CITs work to become better leaders with the end goal of becoming camp counselors.

CITs will have the chance to shadow actual counselors, help facilitate activities and participate in nearly every camp activity. Service work and involvement in the improvement of camp is a crucial part of this program.

The CIT program is an educational program with a curriculum designed to develop the people and technical skills necessary to be an effective camp counselor. A CIT is still technically a camper and therefore bound by many of the same rules and restrictions as regular campers.

CITs will be subject to the same code of behavior and policies as regular staff and will participate in all aspects of camp life.

Under the supervision of a Camp Counselor, CITs will:

•Make camp a fun place to be, helping to devise and plan games and activities.
•Help provide a safe and supportive atmosphere for campers.
•Help campers resolve conflicts.
•Encourage and support campers during individual and camp-wide programming. Instill excitement and engagement in the group and on an individual basis with campers.
•Stay connected with their assigned cabin group at all times and work as a team with their lead counselors.
•Be prepared to lead activities and constantly encourage campers to take responsibility for themselves and others.
•Follow all Camp I-Vy/Camp Huston policies, as well as legal guidelines.
•Routinely check in with their lead counselors and report any
significant issues affecting your campers, cabin, or staff as a whole.
•Assist in the maintenance and upkeep of your cabin, activity areas, and camp.
•Report to all camp events and meals on time.
•Maintain healthy relationships with all camp personnel.
•Act in a courteous and friendly manner and maintain a nonabrasive relationship with all cabin groups.
•Be prepared to receive feedback and support from anyone in camp.
•Maintain a positive and open outlook.
•Be a positive role model for the children. Reward and encourage their good behavior with attention and affection.

Camp Dates: July 27-31, 2026 (CIT’s will come 1 day earlier for training)

CITs are required to attend the staff training on Monday, July 27, 2026.

As staff of Camp I-Vy, I have an obligation to the camp and campers I serve and to maintain the highest standards of ethical conduct. I will not commit acts contrary to these standards, nor will I condone the commission of such acts by others within the camp.

Some examples of unethical conduct are:

• Using campers’ personal and/or medical information for your own use
• Discussing medical information including factor product selection or homecare/pharmacy selection outside of the presence of health center staff
• Influencing campers and peers with my personal opinions of religion, politics, or sexual orientation
• Using intoxicants of any kind

CONFIDENTIALITY

The undersigned, as a condition to attending or participating in the BDFW Camp I-Vy summer camp program, and in consideration of such participation, agrees that he or she will not use any information obtained as a result of his or her participation for any purposes other than participation in Camp I-Vy. Without limiting the foregoing, the undersigned agrees that, while participating in Camp I-Vy he or she shall not solicit addresses of those affected by a bleeding disorder and related complications, including HIV infection or hepatitis, nor shall he or she use any information obtained as a result of participation in Camp I-Vy for any financial or commercial gain. The undersigned also agrees that this agreement is reasonable, that he or she intends to be bound by this agreement and in the event of any violation of this agreement; he or she agrees that this agreement may be enforced by injunctive relief.

CONFLICT OF INTEREST

I have a responsibility to avoid any direct or indirect, actual or apparent, conflicts of interest. I will advise the Camp Directors of any potential conflicts. I will refrain from engaging in any activity that would prejudice my ability or the ability of others to carry out duties ethically.

LEGAL ASSURANCE

I have the responsibility to report any future allegations of criminal activities, investigations, arrests, and/or convictions involving myself, to the BDFW as long as I am on staff with Camp I-Vy.

INTEGRITY

I have a responsibility to refrain from either actively or passively subverting the attainment of the BDFW’s legitimate and ethical objectives. I will refrain from engaging in or supporting any activity that would discredit the BDFW. I will perform my duties in accordance with relevant laws, regulations and camp policies and standards. I will represent the interests of all people served by this camp and will not favor special interests inside or outside BDFW.

I understand the concepts of ethics and conflicts of interest. I represent that I have not been party to an unethical or conflicting action that has not been previously disclosed. I also agree to report any future conflicts of interest or observed unethical activity. I do not currently have any criminal proceedings pending against me, nor have I been placed under arrest or been convicted of a criminal offense within the past year.

The Bleeding Disorder Foundation of WA/Camp I-Vy camp adheres to the highest safety standards and regulations. Camp I-Vy Summer Camp seeks to inspire children within the bleeding disorder community to develop independence, explore, leam, make friends, and become their greater selves through a week of outrageously fun activities in a safe and secure resident camp environment.

Disciplinary Process: Most disciplinary situations at camp are minor and can be resolved with minimal corrections. A disciplinary action at camp is never physical. Initially, discipline can be in the form of a verbal reminder of cabin and camp-wide rules, or if necessary, may entail the camper missing all or part of an activity. Camp staff members use discipline as a learning opportunity for the camper and try to integrate problem-solving skills into the discussion. However, if the negative behavior continues the following steps may be instituted:

1. Discussion between camper and counselor with set goals and objectives.
2. Discussion between camper, head counselor, or camp director regarding expectations.
3. If the conduct continues, a documented behavioral contract may be instituted and signed by camper, counselor, and camp director.
4. Camp Director will contact parent/ guardian to inform them of situation and to discuss possible options up to and including shortening the camp stay.
5. Camp Director will contact parent/ guardian to make arrangements for the camper to be escorted home.

Although the above steps may be implemented, camp administrative staff retains the right to take immediate action if the camper's behavior poses a threat to their own safety, the safety of other campers, or the camp staff. There will be no refund of any amount for campers who are sent home because of behavior problems. Tobacco products, alcohol, illegal drugs, weapons, and sexually explicit material and/or behavior are grounds for immediate dismissal from camp.

The following rules and regulations apply to all campers. The rules and regulations apply for the entire week while camp is in session. Please read them carefully and accept them by placing your signature where indicated:

1. Camp is about fun/ exploration/ and growth. Respect for all in this process is the basic expectation.
2. Possession of personal electronic devices including cell phones, electronic tablets, gaming devices, etc is prohibited. If found at the camp, they will be held by the camp director until the end of the camp session.
3. Possession of weapons of any kind including sling shots, knives, pellet guns, and water guns are prohibited. If found at the camp, they will be held by the camp director until the end of the camp session.
4. Respect the animals and plant life on the hosting camp, Camp Huston grounds and wherever camp activities take place.
5. Hike only on designated hiking trails.
6. For the health of all campers, pets of any kind are not allowed on the Camp
   Huston grounds.
7. As Washington Health Department regulation, campers are not allowed to sleep on the cabin floor.
8. Report any broken equipment or damage to camp property to the camp director immediately. Payment for damage to camp property beyond normal wear and tear will be the responsibility of the parties involved.
9. Rooms must be clean and in order at the end of the camp session.
10. Food and beverages are not allowed in the sleeping rooms and pool area.
11. Shirts and shoes or sandals are required to be worn at all meals in the dining
    hall.
12. Immediately report bleeds, cuts, scrapes and other injuries requiring medical
    attention to the staff nurse or doctor.
13. Campers must respect the rights of privacy of others.
14. All campers are to be in their assigned cabins and quiet at lights out.

I, the camper/CIT, accept the rules and regulations above and agree to follow them at
all times while at Camp I-Vy/Camp Huston.

At camp, your child will have the opportunity to learn self-infusion/infusion
instruction on a voluntary, informal and individual basis by trained medical staff.
Your child can receive this important training when the camper needs factor
replacement during camp, but only if the child is voluntarily ready to infuse themself
or their sibling. I grant permission for my child to receive infusion instruction.

I grant permission for my child to receive treatment for bleeding disorders, including infusion of factor and/or accessing port, while at camp. I grant permission for my child to receive treatment for any medical problems while at camp.

If your child has a minor health problem that can be treated with over the counter medications, ointments, bandages or splints, the health hut staff, physical therapists or physicians may provide care if you approve. A small supply of over-the-counter medications is available at camp. These medications are dispensed, as needed, under the standing orders of the WACBD camp health hut team. Your personal physician does not need to sign for the medications listed below. The health history form is checked for allergies before any medication is given. List all medications you do NOT approve to be administered to your child if needed. Medications stocked at camp are listed below. Brand names have been listed, but their generic equivalent or the same medication of a different brand name may be substituted. Injectable Epinephrine is a prescription medication that is kept on site for use in the event of a life-threatening allergic reaction.

I authorize the Bleeding Disorders Camp health hut team to dispense over-the-counter medication under the direction of the consulting physician's standing orders, as needed, to my child while at Bleeding Disorders Camp.

Taken by Mouth:

• Non-aspirin pain/fever relievers [acetaminophen/Tylenol], liquid, gel caps and pills
• Decongestants
• Ibuprofen
• Imodium (anti-diarrheal)
• TUMS, Maalox or other antiacid
• Throat lozenges (Cepacol)
  Creams & Ointments:
  - Antibiotic cream or ointment
  - Cream for itching (Hydrocortisone)
  - Sun burn cream or gel (Aloe Vera)
  - Blistex
  - Silvadene (for burns)
  - Athlete's foot cream (Lotrimin)
  - Calamine lotion
  - EMLA or other numbing cream
  - Sunscreen
  Sprays & Others:
  - Afrin/Neo-synephrine
  - Nasal Cease
  - Nasal QR
  - "Bug" spray
  - Throat spray (Chloraseptic)
  - First aid spray (Bactine)
  - Soap for posion oak (Teonu)

I give my permission for my camper to take part in all camp activities. In consideration of the benefits derived from my child's attendance at Camp I-Vy, I expressly waive all claims against the camp and its staff, the Bleeding Disorder Foundation of Wa, it's officers, trustees, agents and employees on account of any accident, injury and/or illness that may occur to my child during camp.

From time to time, the Bleeding Disorder Foundation of WA, will want to use
pictures from camp to promote Camp I-Vy and Bleeding Disorder Foundation of WA
activities. We would like permission to be able to use your child's image for that
purpose. I give my permission to use my child's image in print, video, or electronic
media, including internet and social media.

Please read this document carefully. It must be signed by all Participants attending
or participating in programs and activities at Camp Huston, or by at least one parent
or guardian of all Participants who are under the age of 18 as of the date of
attendance at the camp.

It is acknowledged that attendance at and participation in camp activities at Camp
Huston exposes participants to certain risks that cannot in all cases be reasonably
anticipated or avoided, including the risk of property damage, illness, bodily injury
and death. In consideration of Participant's attendance at participation in such
activities, and the use of any facility or equipment of Camp Huston, and
engagement in and/or receipt of instruction in any activity or activity incidental there
to, the undersigned hereby (1) expressly assumes all such risks, known and
unknown and inherent or not; and (2) voluntarily and absolutely releases,
discharges, waives and relinquishes any and all claims, liabilities, demands,
damages or actions, of any form or nature, for property damage, bodily injury and
death, arising from or in any way relating to Participant's attendance at and
participation in activities at Camp Huston, including, but not limited to the use of any
facility or equipment of Camp Huston, and engagement in and/or receipt
of instruction in any activity or activity incidental thereto.

The foregoing release, waiver and discharge of claims shall be extended and be
effective as to Camp Huston, Inc., an Washington nonprofit corporation, and theirrespective directors, officers, employees and agents, to the fullest extent permitted by Washington law.

This agreement is entered into voluntarily and after careful consideration of its
terms, and shall be binding upon the Participant and the undersigned
Parent/Guardian, if signed by a Parent/Guardian, and their respective heirs,
successors, personal representatives and assigns.