2026 High School Camp Med Application/Registration Form

Camper Application & Registration

We’re excited to share that Camp Med 2026 is FREE! Because space is limited, campers will be selected through a simple application process rather than on a first‑come, first‑served basis. Applicants will be asked to answer a few short questions to help us better understand each applicant’s interest and readiness to participate in Camp Med. Applications are open April 1–May 6, and accepted campers will be announced the following week.
NOTE - Students need to have completed 8th, 9th, 10th, 11th, or 12th grade before they are eligible to particapte in High School Camp Med. High School Camp Med is for current 2026 seniors and incoming high schoolers for the 2026-2027 school year (9th, 10th, 11th, and 12th graders).

NOTE - If you need to register an additional camper, you will have to submit a separate registration form.
Parents & Guardians,

To apply for Camp Med, please have your camper answer the questions below. Short answers are just fine, and parents or guardians are welcome to help. Due to limited space, not all applicants may be able to attend, but we truly appreciate everyone taking the time to share.
What interests you about Camp Med?*
Kindness matters in healthcare and at Camp Med. Name one simple way you could show kindness to someone who is having a tough day.*
Camp Med is about learning and seeing things from different perspectives. Please complete the following sentence: Understanding different perspectives is important because ____________________.*

Camper Information
Camper Name*

First NameLast Name
Nickname
Date of Birth*

MonthDayYear
Date
Please select the grade you will enter for the 2026–2027 school year, or choose “Current Senior (Class of 2026)".*
School Camper Attends*

Parent/Guardian Information
Parent/Guardian Name*

First NameLast Name
Relationship to Child*
Email*
example@example.com
Preferred Phone Number to be Reached at During Camp Hours*
Please enter a valid phone number.Format: (000) 000-0000.

Emergency Contacts/Authorized Pickup

List the name of at least one person who can be contacted in the event of an emergency or illness if you cannot be reached. Any person listed should be able to assist in contacting you. At least one person listed must be within one hour of the center/home, able to take responsibility for the child in case the parent/guardian cannot be contacted, and should be at least 18 years of age.
- Full Name*
  
  First NameLast Name
- Primary 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.
- Relationship to Child*
- Please list any additional people, besides your emergency contact(s), who may pick up your camper from camp or let us know that you give permission for your child to walk home after camp.
- Full Name
  
  First NameLast Name
- Primary 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.
- Relationship to Child

Medical / Health Information
Please list and explain any food, medication, or environmental allergies we should be made aware of.
Does your child have a special health or medical condition we should be made aware of? If so, please explain.
Does your child have any dietary restrictions? If so, please explain.
List any additional information about your child that you feel would be useful for staff to know.

Policies and Procedures
EXPECTATIONS:

All campers are expected to be kind and courteous to FMDH staff, fellow campers, and themselves. We expect all campers to listen and follow safety protocols during sessions. We want all campers to have a safe and enjoyable camp experience.

PHONE USAGE:

Phones will be checked-in at the beginning of the day, due to the distracting nature of cell phones. Phones will be returned to campers at pick-up. If there is an emergency/urgent matter to where your camper needs to be reached, you may call/text the Camp Coordinator at (228) 623-1977 or call the hospital directly at (406) 228-3500.

DRESS CODE:

No offensive content on clothing.

THINGS NOT TO BRING TO CAMP:

Money, video games, toys, personal sporting equipment, electronic devices, weapons, knives, drugs, alcohol, and tobacco. (Phones are welcome to be brought to camp and checked in upon arrival and then returned at the end of the day.)

FORBIDDEN BEHAVIORS:

Bullying
Fighting
Threatening others
Using profanity
Stealing or damaging camp property or the property of others
Leaving a program or activity without permission
Endangering anyone's health or safety
Smoking tobacco products or using e-cigarettes
Using alcohol or drugs
Sexual conduct
Bringing weapons onto camp property

DISCIPLINARY PROCESS:

At FMDH CAMP MED our first response is a verbal warning (ideally one-to-one basis as not to embarrass the camper). If the behavior continues, the camper may have time away from the group, a withholding of privileges, or removal from a group activity for a day. If misbehavior still continues, a report to the parent or guardian will be sent. Beyond that, a conference with the parent or guardian and counselor might be needed, and if all else fails, there will be a suspension or expulsion from camp.

In summary: warning, consequence, report to parent/guardian, suspension or expulsion.

Assumption of Risk and Release of Liability, Statement of Understanding, and Media Release
- I understand that my child's participation in FMDH CAMP MED is voluntary. I recognize that the program is designed to use engaging teaching techniques for various healthcare topics. My child will choose their level of participation in any activity. I understand that healthcare lessons entail certain risks. Those risks can include queasiness, increased heart rate, blood pressure, psychological injury, or any possibility of other serious injuries. I elect to have my child participate in spite of these risks. Therefore, my child and I knowingly and voluntarily assume all risks involved in their participation, and do hereby release of FMDH CAMP MED, and its members, trustees, officers, employees, independent contractors and agents from any and all liability, damages, costs, and expenses arising out of or relating to bodily or psychological injury, loss of personal property that may occur as a result of participating in this program, regardless of the cause. Should my child be injured during this activity, I hereby authorize any medical care that is deemed in their best interest.
  
  My child and/or I have read, understand and accept the terms and conditions stated herein and acknowledge that this agreement shall be effective and binding upon the parties during the entire period of participation in the said program. I have informed FMDH CAMP MED in this form of any relevant medical conditions that could affect my child's participation in this program. I am signing this form of my own free will and I am not under duress to sign this form.
- YesNo
- * I have reviewed and accepted FMDH CAMP MED's policies and procedures listed in this form.
  *I agree to reinforce the established expectations, policies and procedures, and rules for the safety of my child, other campers, and camp leaders.
  * I understand that the FMDH CAMP MED is not responsible for the loss or misplacement of camper belongings.
  * I understand that my child may not be released to anyone without prior written documentation and presentation of a valid photo identification.
  * I agree to hold harmless FMDH CAMP MED, its agents and employees for all incidents alleging bodily injury or property damage or loss occurring while the person herein described is a participant at FMDH CAMP MED. I will not hold harmless FMDH CAMP MED from any liability arising out of negligence of FMDH CAMP MED.
  * The information given in the registration and medical information paperwork is correct and complete to the best of my knowledge and the person herein described has permission to engage in all activities in the program, except as noted. All necessary and important medical information regarding my child has been documented on the medical forms provided in the registration paperwork.
- YesNo
- I hereby grant FMDH the absolute and irrevocable right and permission, in respect of the photographs and/or video taken of me alone or with others, to use, re-use, publish, and re-publish the same in whole or in part, individually or in conjunction with other photographs or video, and in conjunction with any printed matter, or electronic matter, in any and all media now or hereafter known, for purposes of art, advertising, education, or promotion. I hereby release and discharge FMDH from any and all claims and demands arising out of or in connection with the use of the photographs or video, including without limitation any and all claims for libel or invasion of privacy.
- YesNo
- Should be Empty:

Camper Application & Registration

Parents & Guardians,

Camper Information

Parent/Guardian Information

Emergency Contacts/Authorized Pickup

Medical / Health Information

Policies and Procedures

Assumption of Risk and Release of Liability, Statement of Understanding, and Media Release