The information on this form is required to assist us in identifying appropriate care for volunteers. This form is to be completed by the volunteer. All forms must be completed to process this application.

References & Experience - Please answer all questions are thoroughly as possible. 

Medical Information

Reminder that food is not allowed to be stored in the cabins.

I have filled out a staff application for Camp Frozen Chozen. I state that the information is complete and accurate. I authorize investigation of all statements herein, including the release of information regarding my qualifications, background, and fitness for this position to Camp Frozen Chozen. 

 I consent to any tests that may relate to my health and fitness for this position, including tests for drugs and alcohol. I agree to undergo a background check. I consent and request that all such persons or agencies accept a photocopy of this authorization as valid authorization to give such information or records. 

 I understand that a complete application is not a guarantee of acceptance and is subject to review by the Alaska Hemophilia Association. I release from all liability all individuals of organizations that provide information about me regarding this application and release the camp or its agents or employees, including the Alaska Hemophilia Association and its Camp Committee. 

I am aware that being accepted as a camp counselor and/or volunteer, I am committed to complete the training requirement by attending any mandatory training required by Camp Frozen Chozen. 

I understand that by volunteering for camp that I am making a commitment for the entire session.  Early departure from the program is unfair to the campers and other volunteers and therefore is not encouraged.  Volunteers are expected to remain on the camp property at all times during the camp session unless otherwise directed by the Camp Director.

I am 18 years old or older. I have not been convicted of any crime involving children under the age of 18 years old or otherwise. I attest that all information provided by me is true and complete to the best of my knowledge.  I understand that any false statements will be considered cause for dismissal. 

Authorization and Acknowledgments

Camp Frozen Chosen (“CFC”) is operated by the Alaska Hemophilia Association (“AHA”) to serve and support the Alaska bleeding disorder community.  By signing this waiver and consent, I, the legal parent/guardian grant permission for myself/my children to attend CFC and participate in any and all “Camp Activities” including but not limited to transport to and from camp provided by AHA, climbing/hiking/trekking, camping, lifeguard supervised-swimming, boating, fishing, archery, guided horseback riding, rock climbing wall, and rope challenge courses unless otherwise specified on the Family Medical Form or Camper Medical Form.  I recognize and acknowledge the inherent risks that these Camp Activities may present for me/my children, and I assume and accept full responsibility for myself and my children for all such risks, including risks related to negligence of third parties and of AHA and CFC staff.

I acknowledge that the possession of use of alcoholic beverages and illegal drugs are strictly forbidden. I understand the possession of any weapon (firearm, knife, explosives, etc.) is strictly forbidden on camp property.

I authorize AHA to release my demographic information to supporting affiliates who help with the cost of my child attending camp.

I acknowledge no family animals/pets will be allowed on the premises of CFC with the exception of service dogs.

Medical Consent

AHA will make every effort to contact those specified in the contact information forms in the case of an emergency. I hereby authorize any and all medical treatment deemed necessary for me and my children by AHA and CFC staff while participating in CFC and Camp Activities, and give permission for AHA and CFC medical staff to administer any medications needed and to provide and arrange for any necessary medical treatment to myself/my children while at CFC, including onsite and offsite emergency care. I accept responsibility for the costs of all such medical treatment.  I further agree that, in the event that AHA deems it necessary to administer, or have administered, emergency first aid or CPR, to remove and/or evacuate me and/or my children from CFC, or to seek emergency medical care for me and/or my children that I am giving AHA and CFC Staff permission to administer or have administered emergency first aid or CPR, secure emergency transport or medical care, and/or disclose any medical information it may have about me/my children to any health care provider which may become involved in the care, treatment, or removal from CFC. By signing this document, I am waiving any right to object to or bring any type of action or claim against AHA and CFC Staff for its administration of, or having administered, emergency first aid or CPR, or for securing emergency transport or medical care and/or for the disclosure of personal medical information it may have about me to any health related person who becomes involved in my/my children’s care or removal from CFC.  I further certify that I have adequate and appropriate insurance to cover all costs associated with any injury, damage, or emergency transportation I and/or my children may cause or incur while participating in the Activity, or in its absence, I agree to bear all costs associated with such injury, damage, or emergency transportation myself, and to indemnify AHA for all such related expenses, including transport and treatment costs.  

 

Participation Release and Waiver

Because I acknowledge, understand, and accept the risks of attending myself or allowing my children to participate, I hereby voluntarily release, forever discharge, and agree to indemnify and hold harmless CFC AHA and its trustees, directors, officers, employees, agents, affiliates, volunteers, and CFC medical staff from any and all damages, claims, demands, lawsuits, causes of action, and liabilities of any nature which in any way arise out of or relate to my or my children’s participation in CFC and Camp Activities and/or my or my children’s use of AHA and CFC equipment or facilities, including any such claims which allege negligent acts or omissions of AHA and CFC Staff whether related or unrelated to the inherent risks set forth herein.

Participation in Medical Infusion Education

Because I acknowledge the risks of attending myself or allowing my children to participate, I agree to release and hold harmless CFC and its founder, trustees, directors, officers, employees, agent, affiliates, volunteers and medical staff (“Staff”) from any and all injury claims of any other nature which may result from my/my children’s participation in education regarding self-infusion or infusion support skills.  I agree to indemnify and hold CFC, its Staff and other children at CFC harmless from any and all liability cause by myself/my children, whether or not intentional.

Photography/Video/Digital Media Release

In consideration of my/my children’s participation at CFC, and without any further consideration from CFC, I hereby grant permission to CFC and Staff to utilize my appearance, performance or voice in any and all manner and media throughout the world for the purpose of promoting, reporting or publicizing CFC. Camp Frozen Chosen may use my/my children’s first name, likeness, voice and biographical material in connection with publication, promotion, exhibition and distribution of such material. 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 any photograph or video or other digital media.

THIS RELEASE IS A BINDING AGREEMENT THAT PREVENTS YOU FROM BRINGING A LAWSUIT AGAINST THE RELEASED PARTIES.  PLEASE READ IT CAREFULLY BEFORE PROCEEDING. YOU ARE GIVING UP ALL YOUR RIGHTS (AND THE RIGHTS OF YOUR HEIRS, ASSIGNS, AND ESTATE) TO BRING LAWSUITS OR MAKE CLAIMS AGAINST THE RELEASED PARTIES. 

I HAVE READ THE FOREGOING ACKNOLWEDGEMENT OF RISKS, ASSUMPTION OF RISK AND RESPONSIBILITY, AND RELEASE OF LIABILITY AND UNDERSTANDING ALL THE ABOVE, I AGREE TO THE TERMS OF THIS RELEASE.

If you have any questions, you may contact Alaska Hemophilia Association at (907) 343-9232.