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2022 MS Adventure Camp - VA Camper Application

 

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You may experience technical difficulties when submitting an application using Internet Explorer. If possible, we would encourage you to use an alternate browser such as Google Chrome or Firefox in order to complete a MS Adventure Camp application.  

MS Adventure Camp - VA Overview

MS Adventure Camp will take place at Camp Holiday Trails in Charlottesville, VA from August 7-10, 2022. This camp is for youth going into grades 4-12 who have a parent with MS or a residing household member who has MS. The application deadline is June 30.  Applications submitted after the deadline will be evaluated on a case-by-case basis for acceptance.

Important note: This form must be filled out by the parent or guardian of the child(ren) interested in attending MS Adventure Camp. A separate application must be filled out for each child interested in attending camp.

Space at camp is limited; incomplete applications or those received after the deadline date may be placed on a waiting list.

This application form does not guarantee acceptance. Families will not receive notice of their acceptance to MS Adventure Camp until after the application deadline date has passed. At that time, families will be asked to complete additional paperwork necessary for attending camp.

Please do not send payment at the time of application. Upon acceptance you will be asked to submit payment for camp. The fee to attend camp is $200 per camper.  During the acceptance process, payment will be requested and is a pay-what-you-can system.  We do request a minimum payment of $25 per family, up to the full amount of $200 per camper. No one will be turned away because of inability to pay. 

All participants are responsible for their own transportation to and from camp.

Please note that upon completing this application, you may be contacted by a Society staff member or the MS Adventure Camp Behavioral Specialist. This check-in is done to determine how to give your child the best MS Adventure Camp experience possible.

MS Adventure Camp - VA COVID Policies

The health and safety of staff, volunteers, and our communities is a top priority as we move through the COVID pandemic together and we would like you to be aware of the following safety guidelines prior to camp. Changes in safety protocol may be required due to special circumstances or local mandates. Stay tuned to all communication about MS Adventure Camp so you can be prepared.

  • Vaccinations will be required for all campers, volunteers, and staff members.  
  • All attendees, regardless of vaccination status, are required to wear a mask indoors except while eating or drinking. Masks will not be required in camper cabins. There may be some activities during which masks outdoors will be required. In all other instances, masks outdoors will be strongly encouraged.
  • Society events are planned to allow for physical distance between staff, volunteers and participants whenever possible.
  • We follow CDC guidelines for routine cleaning and sanitizing of restrooms, shared spaces, and high-touch surfaces, as well as ensure adequate handwashing supplies and/or hand sanitizer.
  • Keep your child home if they experience any COVID-19 symptoms within 24 hours prior to MS Adventure Camp or are exposed to anyone who is positive for COVID within 14 days prior to MS Adventure Camp.

Please contact Brittany McGarry at brittany.mcgarry@nmss.org with questions.

1. Please complete the following with parent name and information.

If you have previously registered, please login here to prepopulate your information.

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Name:

 

 

   

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City/State/ZIP:

 

    

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What's this?

Please enter a username and password that you can use when you return. You can use this password to update your information or receive personalized content.

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5 to 60 characters

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12 to 99 characters

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Question - Required - Please indicate your child's gender.





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Question - Required - In order for us to appropriately and respectfully address your child, please indicate their preferred pronouns.




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Question - Required - Youth's date of birth:




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*16. This camp is for youth who has a parent with MS or who lives in a household with someone with MS. Who in this child's family has MS?
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Question - Required - If accepted, camp materials are available in both paper and electronic versions. Please let us know which way you would prefer to receive these documents.


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Camper Health Information

This information will be kept on file with the National MS Society and shared with camp medical staff as needed. It's used to evaluate our ability to best support you camper and facilitate a safe and enjoyable experience for youth, volunteers, and staff. Confidentiality is respected. 

Please note that you will be required to provide a copy of your child's health insurance card. In addition, parent(s)/guardian will assume the full cost of any medical or hospital expenses incurred at MS Adventure Camp.

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Question - Required - Date of last tetanus shot:




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Question - Required - Date of last DPT shot:




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Question - Required - Date of last measles shot:




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Question - Required - Date of last rubella shot:




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Question - Required - Date of last polio shot:




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Question - Required - Date of last mumps shot:




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Question - Required - Date of last HIB shot:




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Question - Required - Date of last COVID vaccine:




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Question - Not Required - Chronic Concerns: Check all that pertain to this camper.

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Medication

All medications will be collected by the Camp Health Care Provider and will be kept in the camp Health Service Building. Please send only enough medication to last the entire session. 

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Over the Counter Medications: We will be providing the medications listed below through the on-site Healthcare Center. If your child uses an over the counter medication that is listed, you do NOT need to send that medication to camp. If your camper takes a medication that is NOT listed, you may send the amount they will need for their stay at camp in its original packaging. Please include that medication in your child's medication list.

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Question - Not Required - Please check the box next to any over the counter medication in the list below that you DO NOT want the health care staff to administer to your child:

  Camper Experience
 
The following questions are asked to allow camp volunteers and staff better know your child in order to provide a positive, healthy, and safe experience for all campers. The information provided will be shared with camp volunteers and staff as needed. Confidentiality is respected.
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Please indicate your agreement and understanding by placing your initals next to each of the remaining items:

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*73. How did you hear about MS Adventure Camp?
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OVERNIGHT PROGRAM RELEASE AND WAIVER OF LIABILITY

For consideration of attendance at MS Adventure Camp at Camp Holiday Trails to be held from August 7-10, 2022 I waive and release the National Multiple Sclerosis Society (“Society”) and Camp Holiday Trails ("CHT"), its chapters, directors, officers, administrators, representatives and executors, past and present employees, volunteers, agents, supervisors, participants, all state and local governments, assigns, all sponsors, their representatives and successors(collectively, the “Releasees”), from any and all claims, liabilities, or cause of actions arising out of an injury to me (or my child) and from any and all claims, liabilities, or cause of actions arising from my (or my child’s) attendance in and transportation to and from this Event.

Inherent and Potential Risks

I understand that attending MS Adventure Camp may involve strenuous physical activity, exposure to the outdoors, animals, wildlife, and natural hazards. I understand that these activities, by their very nature, carry with it certain inherent risks. I assume all risks associated with attending MS Adventure Camp including all risks relating to strenuous physical activity, exposure to the outdoors, animals, wildlife, and natural hazards. I acknowledge that I may incur minor injuries, major injuries, and catastrophic injuries including paralysis and death. I assume risks from contact with other participants, negligent or wanton acts of other participants, failure of other participants and non-participants from observing the guidelines of the Event, any defects of conditions of premises, and the effects of weather including high heat, thunderstorms, lightning, precipitation, cold temperatures, high winds, and/or humidity.

I assume all risks associated with consuming any food or drink available at the event. I am solely responsible for any adverse health effects from food or beverage consumption, regardless of any allergy, known or unknown, that I (or my child) may have.

I agree to follow the Society's Event Guidelines and will follow the specific rules, regulations and guidelines established by MS Adventure Camp.

I agree to dress myself (or my child) appropriately as to mitigate risk of physical injury to myself (or my child) including, but not limited to: wearing shoes appropriate for strenuous physical activity involved in MS Adventure Camp; and dressing in conjunction with the weather.

I agree that the Releasees are not responsible for any personal items or property lost or stolen before, during, or after MS Adventure Camp.

Weapons are strictly prohibited at Society events. I agree not to bring a weapon of any kind to the event, including all Society sponsored pre and post event activities.

Medical Evaluation

I attest that I (or my child) am medically and physically able to participate in MS Adventure Camp. If I experience any doubt as to my (or my child’s) ability to successfully and safely participate in and/or complete MS Adventure Camp, I take full responsibility for consulting a physician. I attest that, if I (or my child) am pregnant, disabled in any way, or have recently suffered an illness, injury, or impairment, I (or my child) should have or did consult a physician prior to participating in MS Adventure Camp.

I consent to emergency medical care and transportation in order to obtain treatment in the event of injury to me (or my child) as medical professionals may deem appropriate. This Release extends to any liability arising out of or in any way connected with the medical treatment and transportation provided in the event of an emergency, including, but not limited to, negligence emergency rescue operations.

Voluntary Participation

I am fully aware of the risks connected with participation in MS Adventure Camp, whether specifically listed in this Release or not, and I voluntarily elect to participate in MS Adventure Camp knowing that this participation involves these risks.

Assumption of Risk, Waiver of Liability, Release, and Covenant Not To Sue

In consideration for being permitted to participate in MS Adventure Camp, I voluntarily agree for myself, my family, heirs, assigns, executors, and administrators to the following:

1. TO ASSUME FULL RESPONSIBILITY FOR ANY RISKS OF LOSS, OR PERSONAL INJURY, INCLUDING DEATH that may be sustained by me (or my child), or any loss or damage to property owned by me (or my child), as a result of participating in MS Adventure Camp.


2. TO RELEASE, WAIVE, HOLD HARMLESS, DISCHARGE, AND COVENANT NOT TO SUE the Releasees from any and all liability, claims, actions, demands, expenses, attorney fees, breach of contract actions, breach of statutory duty or other duty of care, warranty, strict liability actions, and causes of action whatsoever, that I might have or may acquire in the future, arising out of or related to any loss, damage, or injury, including death, that may be sustained by me (or my child), or to any property belonging to me (or my child), while participating in MS Adventure Camp including, but not limited to, any claim that the act or omission complained of was caused in whole or in part by the negligence or carelessness of the Releasees.

COVID-19 Acknowledgement

I hereby acknowledge and understand that the 2019 novel coronavirus (“COVID-19”) is extremely contagious and easily spread through air, person-to-person contact, and contact with contaminated objects. People can be infected and show no symptoms yet still spread the disease, which can cause serious and potentially life-threatening illness and even death.

Further, I knowingly and voluntarily agree to follow all required and relevant federal, state, local, and Society guidelines and recommendations to maintain the health and safety of event attendees. I acknowledge that failure to comply with these practices may result in exposure to, or contraction of, COVID-19 and may put others at risk. Prior to the event, I acknowledge and agree that I will fully and truthfully fill out and sign any waivers, releases, and/or questionnaires that may be required of me by the Society as a condition to participate in the event.

Acknowledgment and Compliance with Rules

I agree to observe and obey all rules and safety procedures that accompany MS Adventure Camp and to abide by any decision of an event official relative to my (or my child’s) ability to safely compete in the event. I agree to exhibit appropriate behavior at all times and to obey all laws. Society and event officials may dismiss me (or my child), without refund, should my (or my child’s) behavior endanger the safety of or negatively affect an event, person, facility, or property of any kind.

Activities and Equipment

I understand, acknowledge, and agree that there may be hazards associated with specific activities and activity sites which include but are not limited to: accidents while traveling around the grounds or to and from an activity site, bodily injury or illness or property damage, exposure to temperature extremes, inclement weather and all manner of natural hazards. I understand that as a result of these dangers and other hazards, there is a potential for injury or even fatal injury to other participants or myself. Nonetheless, I VOLUNTARILY DESIRE TO PARTICIPATE IN SUCH ACTIVITIES BEING FULLY AWARE OF THE DANGER AND VOLUNTARILY ASSUME ALL RISKS OF LOSS, DAMAGE OR INJURY.

I further acknowledge that there are no warranties applicable to the equipment provided by CAMP HOLIDAY TRAILS whether expressed or implied. I am accepting all equipment AS IS after having examined the same.

 

Severability

I agree that if any portion of this Release is deemed to be invalid, the remainder of the Release will still be binding and enforceable.

 

I, the parent(s) or guardian(s) of the above-named participant, hereby give my/our approval to this child’s participation in MS Adventure Camp. I represent and warrant that I am legally authorized to sign on the participant’s behalf. I assume all risks and hazards incidental to such participation, and I hereby waive, release, absolve, indemnify, and agree to hold harmless Releasees for any claim arising or of an injury to my/our child and from any and all liability, claims, actions, demands, expenses, attorney fees, breach of contract actions, breach of statutory duty or other duty of care, warranty, strict liability actions, and causes of action whatsoever arising out of or connected with my/our child’s participation in and transportation to and from MS Adventure Camp. I consent to the foregoing and grant permission for my/our child to participate in MS Adventure Camp. I acknowledge I have carefully read, accept, and agree to the terms on this Release, and know and understand their contents and I sign the same on my/our own free act and deed.

 

Sign Off

I, the parent(s) or guardian(s) of the above-named participant, hereby give my/our approval to this child’s participation in MS Adventure Camp. I represent and warrant that I am legally authorized to sign on the participant’s behalf. I assume all risks and hazards incidental to such participation, and I hereby waive, release, absolve, indemnify, and agree to hold harmless Releasees for any claim arising or of an injury to my/our child and from any and all liability, claims, actions, demands, expenses, attorney fees, breach of contract actions, breach of statutory duty or other duty of care, warranty, strict liability actions, and causes of action whatsoever arising out of or connected with my/our child’s participation in and transportation to and from MS Adventure Camp. I consent to the foregoing and grant permission for my/our child to participate in MS Adventure Camp. I acknowledge I have carefully read, accept, and agree to the terms on this Release, and know and understand their contents and I sign the same on my/our own free act and deed. I attest that my/our child, the above-named participant, is a minimum of 8 (minimum age) years of age as of the date of MS Adventure Camp, and that he or she will be accompanied by an adult eighteen years of age or older throughout his or her participation in MS Adventure Camp.

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Question - Required - I acknowledge and represent that I have carefully read, accept, and agree to the terms on this Release and Waiver of Liability stated above, and know and understand their contents and I sign the same on my own free act and deed.

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Photography and Website Release

I hereby grant full permission to Society to use, reuse, reproduce, publish, or republish any photographs, motion pictures, recordings, or any other record of my participation in this event, including all Society sponsored pre and post event activities, in any medium now known or hereafter developed, alone or in conjunction with other material, without restriction as to changes or alterations, as well as to use my name, voice, likeness, and/or other indicia of identity, for editorial, educational, promotional, advertising, and commercial purposes, including without limitation in connection with the solicitation of contributions and the furtherance of the corporate objectives of Society. Further, I relinquish all rights, title, and interest in any and all photographs, motion pictures, recordings, or other records of MS Adventure Camp I may take or capture to Society.

I grant permission for the Society to publish and recognize my participation in Event on its website and have reviewed and consented to the Society’s Online Privacy Policy found at www.nationalmssociety.org/Helpful-Links/Legal-Notice-Privacy-Policy/Privacy-Policy.

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