Dear Parent/Guardian: Thank you for submitting your child’s online application for CCFA’s Camp Oasis of Pennsylvania: August 15

th – 20

th, 2016.

In order to complete the application process, you must now print and submit signed versions of all of the forms that are included in the following pages of this document:

(1) General Authorization & Release Form

(2) GI Medical Professional Form

(3) Behavioral Support Form (only if applicable)

(4) Severe Allergy Action Plan (only if applicable)

(5) Leaders in Training (LIT) Application (only if applicable)

As part of your complete application, you must also submit a:

(1) Signed Medication List (sent via email upon submission of your online application)

(2) $400 Attendance Fee (unless already paid by credit card or awaiting pending status of scholarship application) Please make checks payable to CCFA or call (646) 943 – 7480 to pay by phone. You can pay in installments.

(3) Photograph of Camper (clearly displaying child’s face)

(4) Copy of Insurance Card (both sides)

(5) Copy of Pharmacy Card (only if applicable)

(6) Copy of Immunization Record (only if not submitted online) For your reference, a checklist of these required application items is provided on the next page. In order for your child to be considered for camp, ALL of this information, including full payment, must be sent in no later than July 15

th, 2016. An application is not considered complete until ALL items are received. Although payment is not

needed to review your child’s application, it is still required in order for your child to attend camp and must be submitted no later than the application deadline. Once all of the required items have been received, our Camp Director and Medical Director will review the COMPLETE application, and then we will let you know if camp will be able to accommodate your child.

Because of this careful review process, we will not be able to consider applications received after the deadline. Additionally, applications will be considered on a first come complete, first served basis. Space is limited so we strongly encourage you to submit your complete application as soon as possible.

Thanks again for your interest in CCFA Camp Oasis!

For questions regarding the application process, attendance fee, and scholarship program - please contact National Camp Manager, Daniel Marinoni: (646) 943 – 7480 or camp@ccfa.org.

For questions regarding the camp program (activities, amenities, menu, schedule, etc.) and your child’s acceptance - please contact Regional Education & Support Manager, Caneka McNeil: (301) 287 – 8494 or cmcneil@ccfa.org. Sincerely, Your CCFA Camp Oasis Leadership Team

Camper’s Name: ______________________________________________________ D.O.B.: _____________________

Camp Oasis of Pennsylvania Submit forms to: CCFA, Camp Oasis - 733 Third Avenue, Suite 510 – New York, NY 10017 / Email: camp@ccfa.org / Fax: (212) 779 – 4098

The following is a list of the additional hard copy forms required as part of every application.

Required Application Forms Page of this Packet To be completed and signed by?

Current Medication List NA, came by email Parent/Guardian AND GI MD or NP

General Authorization & Release Form 3 Parent/Guardian

GI Medical Professional Form 5 GI MD or NP

Behavioral Support Form (if applicable) 6 Mental Health Specialist/ Prescribing MD

Severe Allergy Action Plan (if applicable) 7 Allergist/ Prescribing MD

LIT Application (if applicable) 9 LIT AND Parent/Guardian

Application Attachments: The following is a list of the additional attachments required as part of every application.

Payment of $400 (unless already paid by credit card or awaiting pending status of scholarship application) Please make checks payable to CCFA or call (646) 943 – 7480 to pay by phone. You can pay in installments.

Photograph of Camper (clearly displaying the child’s face)

Copy of Insurance Card (both sides)

Copy of Pharmacy Card (only if applicable)

Copy of Immunization Record (only if information was not relayed in online application)

CLARIFICATIONS ON HARD COPY APPLICATION FORMS:

Current Medication List

o This list was sent in the body of the email you received upon applying, and reflects the information you supplied in the online application. It must be reviewed and signed by you and your child’s GI physician or nurse practitioner. Any changes that are written in must be initialed by you and your child’s GI physician or nurse practitioner. This list must be signed and submitted even if your child is not currently taking any medication.

Medical Professional Form

o Camp policy requires that every camper submit a record of having a physical exam within 12 months of camp. Therefore, your child’s GI physician or nurse practitioner must complete this form based on a visit that has occurred since September 2015.

o If your child is not currently seeing a GI, his/her pediatrician should complete the form instead.

Immunization Record

o Camp policy requires that your child’s immunizations be up-to-date. If you are uncertain of your child’s status, please check

with his/her doctor, and arrange to have any necessary vaccines given. CDC guidelines are included.

o If your child has not been vaccinated due to medical, personal, or religious reasons, you will need to request an Immunization Release Form from CCFA, and include it as part of your child’s application. Email camp@ccfa.org to request this form.

Behavioral Support Form

o This form must be submitted if your child (1) has a behavioral, emotional, or mental health diagnosis, (2) has seen a mental health professional (i.e. therapist, social worker) in the past 12 months, AND/OR, (3) is currently taking a mood altering medication for ANY reason.

o If your child has seen a mental health professional in the past 12 months, that person should complete the form. If your child has not seen a mental health professional in the past 12 months, the physician who prescribed the medication and/or diagnosed the behavioral, emotional, or mental health condition should complete the form.

Severe Allergy Action Plan

o This form must be completed by your child’s Allergist if your child requires epinephrine when exposed to an allergen.

o If your child is not currently seeing an Allergist, his/her pediatrician should complete the form instead.

SUBMISSION INSTRUCTIONS:

Be sure that all of the attached forms are COMPLETE and have been SIGNED by the appropriate people. Then return them, along

with the other required attachments (e.g., copy of insurance card, photo, etc.) and payment, to the CCFA National Office no later than July 15

th, 2016. Information on how to submit the forms have been included within this packet and can be found at the bottom of every

form. Reminder, applications are considered in the order in which they are received, based on the date the application is fully complete. Some camps are unable to accommodate all applicants so please submit all signed paperwork and payment as soon as possible.

2016 CAMPER APPLICATION CHECKLIST & CLARIFICATIONS

2

Camper’s Name: ______________________________________________________ D.O.B.: _____________________

Camp Oasis of Pennsylvania Submit forms to: CCFA, Camp Oasis - 733 Third Avenue, Suite 510 – New York, NY 10017 / Email: camp@ccfa.org / Fax: (212) 779 – 4098

Name of child who will be a camper at CCFA Camp Oasis: _______ ___ hereinafter referred to as the "Applicant." (Write the child’s name above)

Note: Please read the following information carefully. Every item on this page must be understood before signing.

I certify that I am the parent or legal guardian of the above named Applicant.

I certify that I have provided accurate information in all parts of the application.

I understand that Applicant will be participating in many physical activities at CCFA Camp Oasis and its host site location (hereinafter referred to as the "Camp"), and I give permission for Applicant to engage in all activities except as I have noted on his/her application.

I authorize Camp to release Applicant's records to Camp medical and non-medical staff and to third parties as necessary, for the purposes of Applicant's medical treatment, the non-medical care of Applicant, for the purposes of a referral, billing, or insurance purposes, as deemed necessary by Camp staff.

I authorize Camp medical staff to provide Applicant with medical care and medication according to the instructions provided in the Applicant’s forms, or, for issues not detailed in the forms, as deemed necessary by Camp medical staff.

I authorize Camp medical staff to contact any of Applicant's physicians and mental health providers listed on Applicant’s forms, to obtain any records necessary for treatment, referral, billing, or insurance purposes.

I authorize Camp medical staff to consent to any emergency medical care or treatment, including the dispensing of medicine, examinations, immunizations, x-rays, tests, dental care, anesthetics, medical or surgical diagnosis or treatments, and hospital care, to be rendered to the Applicant as deemed necessary by the Camp medical staff.

I give consent for any transportation deemed necessary or appropriate, at the discretion of the Camp, in connection with the medical treatment of the Applicant.

I assume financial responsibility for any and all medical and other expenses incurred for or on behalf of Applicant while at Camp or offsite.

I authorize Camp to provide transportation to the Applicant, as needed, while the Applicant heads to, attends, and leaves Camp. I release and hold harmless the Crohn’s & Colitis Foundation of America and Camp from all claims, damages and liabilities that may result, directly or indirectly, from any injury that Applicant may suffer during such transportation.

I give permission to Camp to use Applicant's name, photographs, and other reproduction(s) and likenesses in connection with activities, publications, and media publicity of Camp and the Crohn’s & Colitis Foundation of America.

I agree to allow Applicant’s name, mailing address, telephone number, and email address to be included in a CCFA Camp Oasis Directory, which may be distributed to all campers from his/her session after camp has ended.

I agree to be responsible for monitoring Applicant’s contact with all Camp staff and campers once Camp has ended, and for ensuring that Applicant does not post Camp photos or images on social networking websites without CCFA approval.

I agree to be responsible for the pick-up of Applicant if Camp decides to send him/her home due to illness, behavioral/emotional issues, or any serious violation of Camp rules. I agree that Camp shall be the sole judge of what constitutes a serious violation.

I understand that in order for Applicant to attend Camp, I must give up any rights to hold Camp liable for any injury or damage that Applicant may suffer while attending Camp or participating in Camp’s activities.

I voluntarily release and hold harmless the Crohn’s & Colitis Foundation of America, its officers and directors, local CCFA chapters, Camp, and each of their officers, agents, trustees, employees, and volunteers from any and all liability resulting from or arising out of Applicant traveling to/at/from and attending Camp or participating in Camp’s activities.

I have read the above information carefully, and I have fully understood each item. I understand that if I have any questions regarding anything contained in this Release, I may call the CCFA Camp Office.

This Release has been executed as of (today’s date): ___________________________________

Parent/Guardian Name: ____________________________________________________________

Parent/Guardian Signature: ________________________________________________________

NOTE: If you do NOT want your child to be included in the CCFA Camp Oasis Directory, please sign here instead:

Parent/Guardian Signature: _______________________________________________________

2016 GENERAL AUTHORIZATION & RELEASE FORM

3

Camper’s Name: ______________________________________________________ D.O.B.: _____________________

Camp Oasis of Pennsylvania Submit forms to: CCFA, Camp Oasis - 733 Third Avenue, Suite 510 – New York, NY 10017 / Email: camp@ccfa.org / Fax: (212) 779 – 4098

Dear Healthcare Provider, You are receiving this letter because one of your patients is applying to Camp Oasis, the Crohn’s & Colitis Foundation of America’s (CCFA) coed, residential summer camp program for children with Crohn’s disease and ulcerative colitis. In order to attend parents must complete an in depth application process to determine whether CCFA will be able to accommodate their child while away at camp. The information you provide in the forms following this letter will help our medical review team reach a decision so please answer all questions as accurately and with as much detail as possible. Below is a list of the forms that must be submitted, and who or what is required to complete them. Thank you!

GI Medical Professional Form

o Camp policy requires that every camper submit a record of having a physical exam within 12 months of camp.

Therefore, the child’s GI physician or nurse practitioner must complete the form based on a visit that has occurred since September of 2015.

o If the child is not currently seeing a GI, his/her pediatrician may complete the form instead.

Current Medication List

o Must be reviewed and signed by both the parent and the child’s GI physician or nurse practitioner. Any changes that are written in must be initialed by the parent and the child’s GI physician or nurse practitioner. This list must be signed and submitted even if the child is not currently taking any medication.

o If the child is not currently seeing a GI, his/her pediatrician may complete the form instead.

Immunization Record – (can be submitted electronically by parent)

o Camp policy requires that every child’s immunizations be up-to-date. Parents should check with their doctor, and

arrange to have any necessary vaccines given. CDC guidelines have been provided.

o If the child has not been vaccinated due to medical, personal, or religious reasons, they will need to request an Immunization Release Form from CCFA, and include it as part of their application.

Behavioral Support Form – (if applicable)

o This form must be completed by the child’s mental health professional if the child:

Has a behavioral, emotional, or mental health diagnosis.

Has seen a mental health professional (i.e. therapist, social worker) in the past 12 months for ANY reason.

Is currently taking a mood altering medication for ANY reason.

o If the child is not currently seeing a mental health professional, the physician who prescribed the medication and/or diagnosed the behavioral, emotional, or mental health condition should complete the form.

Severe Allergy Action Plan – (if applicable)

o This form must be completed by the child’s Allergist if the child experiences anaphylaxis when exposed to an allergen.

o If the child is not currently seeing an Allergist, his/her pediatrician may complete the form instead.

Submission Instructions Parents are urged to submit all of their forms together. Therefore, these forms should be returned to the parent/guardian to be submitted to CCFA’s National Office. If you are submitting all of the forms on their behalf, they can be faxed to (212) 779 – 4098 or emailed to camp@ccfa.org. If you have any questions, please contact Daniel Marinoni at (646) 943 – 7480 Thank you for your time! Sincerely, CCFA’s Camp Oasis Leadership Team

Letter to Healthcare Providers

4

Camper’s Name: ______________________________________________________ D.O.B.: _____________________

Camp Oasis of Pennsylvania Submit forms to: CCFA, Camp Oasis - 733 Third Avenue, Suite 510 – New York, NY 10017 / Email: camp@ccfa.org / Fax: (212) 779 – 4098

MUST BE COMPLETED & SIGNED BY LICENSED GI PHYSICIAN OR NURSE PRACTITIONER

Date of Most Recent Exam: _______________________ IBD Diagnosis: __________________________________

Disease Extent/Location: __________________ Symptom(s) during a “flare”: ______________________________

Extraintestinal Manifestations: Check all that apply.

Fevers (> 38 C or 100 F) Mouth sores Joints (arthritis/arthralgia) Skin (E. nodosum/P. gangrenosum)

Eyes (uveitis) Headaches Sclerosing chol. Perianal disease (tag/fissure/fistula)

Allergies: ________________________________________________________________________________________

Is the child developmentally appropriate for his/her age? Y / N If no, at what age does the child function: _______

Other Medical, Behavioral or Psychosocial Concerns:___________________________________________________

Significant Events/Surgeries (What/When): ____________________________________________________________

Please include the findings from the child’s most recent exam below.

Weight: ______________ Height: ______________ Growth: Acute Weight Loss Chronic Growth Failure

Abdominal Pain Intensity: Mild Moderate Severe None Frequency of Pain per Day: __________

Type of Stools: Form Semi Loose Blood Mucus Nocturnal Frequency of Stool per Day: _________

Normal Abnormal Comments

EENT

Neck

Lungs

Heart

Abdomen

Anus/Rectum

Muscular/Skeletal

Psych

Lymph

Neuro

Skin

Other

I understand that the above listed individual is seeking to participate in a special overnight camp for kids with inflammatory bowel disease, sponsored by the Crohn’s & Colitis Foundation of America (CCFA), which provides a Medical Team consisting of physician(s) (including a gastroenterologist), nurses, and a mental health professional who will be on-site and on-call 24-hours a day to provide basic care during camp. I understand that this camp program will provide the above listed individual with the opportunity to participate in supervised activities which may include but are not limited to pool/swimming, horseback riding, high ropes course, and organic gardening.

2016 GI MEDICAL PROFESSIONAL FORM

I believe CCFA should ACCEPT or DECLINE this applicant, based on this information and my work with this individual.

Comments/Limitations/Restrictions:__________________________________________________________________________

GI MD/ Nurse Practitioner Name: _________________________________________ Phone: ___________________________

GI MD/ Nurse Practitioner Signature: _______________________________________ Date: _____________________________

5

Camper’s Name: ______________________________________________________ D.O.B.: _____________________

Camp Oasis of Pennsylvania Submit forms to: CCFA, Camp Oasis - 733 Third Avenue, Suite 510 – New York, NY 10017 / Email: camp@ccfa.org / Fax: (212) 779 – 4098

THIS FORM MUST BE SUBMITTED AS PART OF THE APPLICATION IF:

(1) Applicant has been diagnosed with a behavioral or mental health condition (e.g., ADD/ADHD, Anxiety, Depression, PTSD, OCD);

(2) Applicant has seen a mental health professional (e.g., social worker, psychologist, psychiatrist) in the past 12 months, AND/OR;

(3) Applicant has been prescribed or is currently taking a psychoactive medication for any reason.

THIS FORM MUST BE COMPLETED BY:

(1) Applicant’s mental health professional (social worker, psychologist, psychiatrist, etc.), if applicable, OR;

(2) The medical professional that prescribed the medication or diagnosed the behavioral, emotional, or mental health condition.

Name of Person Completing Form: __________________________________________________________________

Profession: ______________________________________ Relationship to Applicant: _____________________________

What initially prompted treatment? family-initiated PMD mandate school referral other: __________________

When did treatment begin? ________________________________ How is patient currently seen?: regularly as needed

Date of Most Recent Visit: __________________________________ Number of Visits in Past 12 Months: ____________________

Most recent/current disposition of treatment & involvement with patient: _______________________________________________

Diagnosis/Reason for Treatment: ____________________________________________________________________

Date of Diagnosis (if formal DSM diagnosis): __________________ Essential Meds for Diagnosis: ________________________

Criteria met that led to diagnosis: _________________________________________________________________________________

Behavioral manifestations that may appear at camp & suggested ways to manage:

To your knowledge, is there or has there ever been concern about any of the following? (Check all that apply.):

Passive or active suicidal ideation or plans Self-harm Impulse control Aggression

If any of these items are checked, please explain:

Due to camper volume, onsite mental health providers may not be able to carry out specialized treatment goals during camp. Can this child function at camp with only basic care from the on-site mental health provider?

YES NO If no, please explain:

I understand that the above listed individual is seeking to participate in a special overnight camp for kids with inflammatory bowel disease, sponsored by the Crohn’s & Colitis Foundation of America (CCFA), which provides a Medical Team consisting of physician(s), nurses, and a mental health professional who will be on-site and on-call 24-hours a day to provide basic care during camp.

2016 BEHAVIORAL SUPPORT FORM

I believe CCFA should ACCEPT or DECLINE this applicant based on this understanding and my work with this individual.

Comments/limitations/restrictions: __________________________________________________________________

Provider Name: ________________________________________________________ Phone: ___________________________ Provider Signature: ______________________________________________________ Date: ____________________________

6

Camper’s Name: ____________________________________________ DOB: ________________

Camp Oasis of Pennsylvania Submit forms to: CCFA, Camp Oasis - 733 Third Avenue, Suite 510 – New York, NY 10017 / Email: camp@ccfa.org / Fax: (212) 779 – 4098

List ANYALLERGY (to food, medicine or other) that may prompt a life-threatening allergic response.

Allergen Severe Reaction Caused When: Required Response Has severe reaction

ever occurred? Dosage & Additional

Instructions

Allergen is ingested

Allergen touches skin

Allergen is in area (air born allergy)

Give epinephrine immediately after known exposure to allergen, even if no symptoms are noted

Give epinephrine at first sign of any symptom

Give epinephrine with signs or symptoms of anaphylaxis

Yes Date: __________

No

Allergen is ingested

Allergen touches skin

Allergen is in area (air born allergy)

Give epinephrine immediately after known exposure to allergen, even if no symptoms are noted

Give epinephrine at first sign of any symptom

Give epinephrine with signs or symptoms of anaphylaxis

Yes Date: __________

No

Allergen is ingested

Allergen touches skin

Allergen is in area (air born allergy)

Give epinephrine immediately after known exposure to allergen, even if no symptoms are noted

Give epinephrine at first sign of any symptom

Give epinephrine with signs or symptoms of anaphylaxis

Yes Date: __________

No

Allergen is ingested

Allergen touches skin

Allergen is in area (air born allergy)

Give epinephrine immediately after known exposure to allergen, even if no symptoms are noted

Give epinephrine at first sign of any symptom

Give epinephrine with signs or symptoms of anaphylaxis

Yes Date: __________

No

Other Non-Life Threatening Allergies & Recommended Treatment:

Note to Allergist: If you do not feel this form adequately addresses your patient’s allergy(ies) please feel free to submit subsequent documentation.

2016 SEVERE ALLERGY ACTION PLAN

MUST BE COMPLETED & SIGNED BY A LICENSED ALLERGIST IF YOUR CHILD REQUIRES EPINEPHRINE

IF YOUR CHILD IS NOT SEEING AN ALLERGIST THEIR PEDIATRICIAN SHOULD COMPLETE THIS FORM INSTEAD YOU MUST SUPPLY TWO (2) EPI-PENS AT CAMP

Allergist’s / MD’s Name:

Phone:

Allergist’s / MD’s Signature: Date:

7

Camper’s Name: ____________________________________________ DOB: ________________

****THIS INFORMATION IS ONLY APPLICABLE TO LIT PROGRAM APPLICANTS***

Greetings Prospective LIT (and LIT Parent/Guardian): For our 2016 camp season, teens entering grade 12 in fall 2016 are only eligible to attend Camp Oasis as part of our Leaders in Training (LIT) Program. Therefore, if you fall within this designation, you must apply to be an LIT and be selected for participation in order to attend camp. Read below for more information on the program and how to apply.

What to Expect Our LIT Program is a special program for teens that are truly interested in developing their leadership skills. LITs are technically still campers – which means they have plenty of time for the usual fun – but they also have some added duties and responsibilities. For example, LITs will be expected to:

1. Abide by all of the camp rules and set a good example for the other campers

2. Work at least one activity period a day with the help of a senior counselor

3. Help organize and run a camp-wide event during the week with the help of other LITs

4. Attend and participate in a daily LIT meeting

5. Stay the entire duration of camp

6. Assist as needed with the bunk-life of the youngest campers

Who Should Apply We are looking for LITs who are responsible members of the camp community. We are looking for those who are able to put the needs of others before their own, and who enthusiastically participate in camp activities. And we are looking for good roles models - those who follow the rules and are respectful towards the other people at camp.

How to Apply If you meet the LIT grade requirement, are willing to fulfill the duties listed above, and believe you can contribute positively to our camp community, please complete the attached LIT Application, and send it in along with the other required hard copy forms by the application deadline: July 15

th, 2016.

After your application is received and has been processed, someone from the Camp Office will contact you about setting up an LIT interview. From there, a decision will be made about whether you will be able to attend. NOTE: Not every LIT applicant is guaranteed a spot in the LIT Program. It is selective. Only those who demonstrate that they have the required interests and skills will be accepted.

If you have any questions about the LIT Program, please contact Caneka McNeil: (301) 287 – 8494 / cmcneil@ccfa.org.

Sincerely, Your CCFA Camp Oasis Leadership Team

2016 LEADERS IN TRAINING (LIT) PROGRAM EXPLANATION

8

Camper’s Name: ____________________________________________ DOB: _______________

Camp Oasis of Pennsylvania Submit forms to: CCFA, Camp Oasis - 733 Third Avenue, Suite 510 – New York, NY 10017 / Email: camp@ccfa.org / Fax: (212) 779 – 4098

***This form must be submitted along with the other required application forms by anyone applying to Camp Oasis as a Leader in Training (LIT).***

LIT Applicant’s Name: _________________________________ Gender: M / F Grade in 2016-17: __________

Address: ______________________________ City: ______________________ State: _____ Zip: ______________

Phone(s): _____________________________________ E-mail Address: ______________________________

1.) Why do you want to be a Leader in Training at CCFA Camp Oasis? (Use other side if necessary.)

2.) What past jobs and/or experiences have prepared you for this role? (Use other side if necessary.)

Leaders in Training (LIT) Program Agreement

I recognize that by applying to serve as a Leader in Training (LIT) at CCFA’s Camp Oasis, I am seeking to join a community of caregivers entrusted with the care and well-being of campers, and therefore agree to adhere to and uphold the following rules and policies:

Attendance: I will attend the entire session of camp and all of its activities, observe the hours of curfew, and never leave campus, unless I make other specific arrangements with the Director beforehand.

Forbidden Items: I will not bring to camp any alcohol, illegal drugs, firearms, knives, fireworks or other explosives, pets, or any other potentially dangerous items.

Dress Code: I will dress appropriately for work and for each activity, as outlined by the Director.

Personal Electronics: I will only use my electronic equipment in areas and times designated by the Director.

Overall Conduct: I will set a good example for all community members, abiding by all rules and showing enthusiasm for camp and its activities.

Conduct with Campers: I will treat all campers with respect, and will NOT: (1) shame them; (2) use profane or sexual language around them; (3) touch them in spots normally covered by bathing suits; (4) touch them against their will; (5) hit or bully them; (6) use corporal punishment; (7) allow them to participate in any activity that is potentially physically or emotionally harmful, including pranks and horseplay; (8) share the details of my personal life with them.

Conduct with Peers and Staff: I will treat my fellow LITs and all staff with respect; and if I have a conflict or concern, I will discuss it in a timely manner with a camp supervisor.

I confirm that I have read each of the above listed items and understand the responsibilities related to serving as an LIT at CCFA Camp Oasis. I also understand that by signing this form, I am promising to abide by these rules and commitments, and that failure to do so may be grounds for dismissal.

LIT Applicant’s Signature: ________________________________________ Date: ___________________________

Parent’s Signature: _____________________________________________ Date: ___________________________

2016 LEADER IN TRAINING (LIT) APPLICATION

9

Upon completion of the hardcopy forms, you must submit them along with the other items requested of you (Insurance Card/s, camper photo, etc.) to the National Office. There are currently three ways to submit your forms/items – mail, email, and fax. Below are detailed instructions on each method as well as advice on how to ensure delivery and expedite processing. Please Note: You are highly encouraged to submit ALL of your hardcopy forms/items at one time. This will lead to faster processing time as less follow up will be required. Thank you!

Mail – (most preferred method)

CCFA, Camp Oasis Attention: Daniel Marinoni 733 Third Avenue, Suite 510 New York, NY 10017 Best Practices

Use certified mail to track your package and confirm delivery

Make a copy of the completed forms/items before sending them in case they get lost in the mail

Do not bend, fold, or crease your forms/items. Use a flat 8.5” x 11” envelope

Do not staple your forms/items together. Use a paperclip or leave them loose in the envelope

Do not send blank or unused forms. Only submit applicable forms that have been completed

Email camp@ccfa.org Best Practices

Request a “Read Receipt” to confirm the email has been received and opened

Include your child’s first and last name, and the camp they are applying to in the subject line

The preferred format for all files is PDF. Other formats such as JPEG will also be accepted

Use higher resolutions for images so they are clear and easy to read and see

Do not send emails over 6MBs. Instead send multiple emails with fewer attachments

Fax – (least preferred method) (212) 779 – 4098 Best Practices

Request a “Confirmation Report” to confirm the fax went through

Send to the attention of “Camp Oasis – Daniel Marinoni”

Always use the highest resolution setting possible

Do not send images or photos. Insurance cards and photos will not come through. Use email instead

Thank you again for your cooperation! Depending on the volume of hardcopy forms/items received, processing times could take as long as two weeks. You can check if your forms/items have been processed at anytime by logging into your account: online.ccfa.org/CampOasisLogin, clicking “View/Edit Forms,” and then clicking “View” next to the 2016 For Campers Only – Forms Receipt Record. If you have any questions please contact National Camp Manager, Daniel Marinoni, at (646) 943 – 7480 or camp@ccfa.org.

Hardcopy Forms: Submission Instructions

Q: Where are the hardcopy forms?

The hardcopy forms can be found via the link in Step 2 of the email entitled, “2016 CCFA Camp Oasis:

Hardcopy Forms to Complete Application.” If the link is not clickable, copy and paste it into your browser. If

pasting the link into your browser does not work please contact CCFA’s National Office.

Q: Where do I submit the hardcopy forms once they are complete? Please submit the hardcopy forms, as well as the attendance fee, to CCFA’s National Office. Mail: CCFA, Camp Oasis – Attn: Daniel Marinoni – 733 Third Ave., Suite 510 – New York, NY 10017 Email: camp@ccfa.org Fax: (212) 779 – 4098

Q: How can I find out if the National Office received my hardcopy forms? You can check if your forms have been received and processed at anytime by logging into your account: online.ccfa.org/CampOasisLogin, clicking “View/Edit Forms,” and then clicking “View” next to the 2016 For Campers Only – Forms Receipt Record. If there is a date written next to the form then it has been received and processed. If there is no date then the form is either missing or it has not been processed yet. Note: Depending on the volume of forms received processing times may take as long as two weeks.

Q: My child’s medication has changed. How can I update their medication list? You can update your child’s Current Medication List at anytime by visiting: online.ccfa.org/CampOasisMedUpdate. Please do NOT submit another application. Note: If you update your child’s medication, you will be required to submit another Current Medication List signed by your child’s GI/NP. If you think your child’s medication might change a second or third time, it’s best to wait and indicate those changes on the “Pre-Camp Update Form” which is sent two weeks prior to your camp’s start date.

Q: My child’s medical history has changed. How can I update their application? Two weeks prior to camp you will receive Pre-Camp Update Form where you can update your child’s application with any recent changes to their medical history. Please do NOT submit another application. However, if your child’s condition has changed significantly (i.e., surgery is now required), please contact your local camp office to share this update as soon as possible.

Q: My child’s application is complete. Now what? A medical review team will review the application and determine whether CCFA can accommodate the child during camp. After being reviewed, the medical team will inform the local CCFA Regional Education & Support Manager (RESM) that the child should accepted or rejected. The RESM will then communicate that decision to you. If accepted, the RESM will become the primary point of contact leading up to camp.

Q: My child can no longer attend camp. Who should I contact? Please contact National Camp Manager, Daniel Marinoni, or your local RESM as soon as possible so that another child can take their place as many of our camps run a wait list.

Q: I have a question. Who should I contact? If you have a question regarding the application process including the online application, hardcopy forms, attendance fee, or scholarship request – please contact, National Camp Manager, Daniel Marinoni: (646) 943 – 7480 / camp@ccfa.org If you have questions regarding your child’s acceptance, the camp host site, or the camp session itself including accommodations, activities, menu, etc. – please contact your local RESM. If you do not know who your local RESM is please visit: www.ccfa.org/chapters

Application Process FAQ

2015 Recommended Immunizations for Children from 7 Through 18 Years Old

7–10 YEARS 11-12 YEARS 13-18 YEARSTdap 1 Tetanus, Diphtheria, Pertussis (Tdap) Vaccine Tdap

Human Papillomavirus (HPV) Vaccine (3 Doses)2 HPV

MCV4 Meningococcal Conjugate Vaccine (MCV4) Dose 13 MCV4 Dose 13 Booster at age 16 years

Influenza (Yearly)4

Pneumococcal Vaccine5

Hepatitis A (HepA) Vaccine Series6

Hepatitis B (HepB) Vaccine Series

Inactivated Polio Vaccine (IPV) Series

Measles, Mumps, Rubella (MMR) Vaccine Series

Varicella Vaccine Series

These shaded boxes indicate when the vaccine is recommended for all children unless your doctor tells you that your child cannot safely receive the vaccine.

These shaded boxes indicate the vaccine should be given if a child is catching-up on missed vaccines.

These shaded boxes indicate the vaccine is recommended for children with certain health conditions that put them at high risk for serious diseases. Note that healthy children can get the HepA series6. See vaccine-specific recommendations at www.cdc.gov/vaccines/pubs/ACIP-list.htm.

FOOTNOTES1 Tdap vaccine is recommended at age 11 or 12 to protect against tetanus, diphtheria and pertussis. If your child has not received any or all of the DTaP vaccine series, or if you don’t know if your child has received these shots, your child needs a single dose of Tdap when they are 7 -10 years old. Talk to your child’s health care provider to find out if they need additional catch-up vaccines.2 All 11 or 12 year olds – both girls and boys – should receive 3 doses of HPV vaccine to protect against HPV-related disease. The full HPV vaccine series should be given as recommended for best protection.3 Meningococcal conjugate vaccine (MCV) is recommended at age 11 or 12. A booster shot is recommended at age 16. Teens who received MCV for the first time at age 13 through 15 years will need a one-time booster dose between the ages of 16 and 18 years. If your teenager missed getting the vaccine altogether, ask their health care provider about getting it now, especially if your teenager is about to move into a college dorm or military barracks.4 Everyone 6 months of age and older—including preteens and teens—should get a flu vaccine every year. Children under the age of 9 years may require more than one dose. Talk to your child’s health care provider to find out if they need more than one dose. 5 Pneumococcal Conjugate Vaccine (PCV13) and Pneumococcal Polysaccharide Vaccine (PPSV23) are recommended for some children 6 through 18 years old with certain medical conditions that place them at high risk. Talk to your healthcare provider about pneumococcal vaccines and what factors may place your child at high risk for pneumococcal disease.6 Hepatitis A vaccination is recommended for older children with certain medical conditions that place them at high risk. HepA vaccine is licensed, safe, and effective for all children of all ages. Even if your child is not at high risk, you may decide you want your child protected against HepA. Talk to your healthcare provider about HepA vaccine and what factors may place your child at high risk for HepA.

For more information, call toll free 1-800-CDC-INFO (1-800-232-4636) or visit http://www.cdc.gov/vaccines/teens

Vaccine-Preventable Diseases and the Vaccines that Prevent Them

Diphtheria (Can be prevented by Tdap vaccine)Diphtheria is a very contagious bacterial disease that affects the respiratory system, including the lungs. Diphtheria bacteria can be passed from person to person by direct contact with droplets from an infected person’s cough or sneeze. When people are infected, the diptheria bacteria produce a toxin (poison) in the body that can cause weakness, sore throat, low-grade fever, and swollen glands in the neck. Effects from this toxin can also lead to swell-ing of the heart muscle and, in some cases, heart failure. In severe cases, the illness can cause coma, paralysis, and even death.

Hepatitis A (Can be prevented by HepA vaccine)Hepatitis A is an infection in the liver caused by hepatitis A virus. The virus is spread primarily person-to-person through the fecal-oral route. In other words, the virus is taken in by mouth from contact with objects, food, or drinks contaminated by the feces (stool) of an infected person. Symptoms include fever, tiredness, loss of appetite, nausea, abdominal discomfort, dark urine, and jaundice (yellowing of the skin and eyes). An infected person may have no symptoms, may have mild illness for a week or two, or may have severe illness for several months that requires hospitalization. In the U.S., about 100 people a year die from hepatitis A.

Hepatitis B (Can be prevented by HepB vaccine)Hepatitis B is an infection of the liver caused by hepatits B virus. The virus spreads through exchange of blood or other body fluids, for example, from sharing personal items, such as razors or during sex. Hepatitis B causes a flu-like illness with loss of appetite, nausea, vomiting, rashes, joint pain, and jaundice. The virus stays in the liver of some people for the rest of their lives and can result in severe liver diseases, including fatal cancer.

Human Papillomavirus (Can be prevented by HPV vaccine)Human papillomavirus is a common virus. HPV is most common in people in their teens and early 20s. It is the major cause of cervical cancer in women and genital warts in women and men. The strains of HPV that cause cervical cancer and genital warts are spread during sex.

Influenza (Can be prevented by annual flu vaccine)Influenza is a highly contagious viral infection of the nose, throat, and lungs. The virus spreads easily through droplets when an infected person coughs or sneezes and can cause mild to severe illness. Typical symptoms include a sudden high fever, chills, a dry cough, headache, runny nose, sore throat, and muscle and joint pain. Extreme fatigue can last from several days to weeks. Influenza may lead to hospitalization or even death, even among previously healthy children.

Measles (Can be prevented by MMR vaccine)Measles is one of the most contagious viral diseases. Measles virus is spread by direct contact with the airborne respiratory

droplets of an infected person. Measles is so contagious that just being in the same room after a person who has measles has already left can result in infection. Symptoms usually include a rash, fever, cough, and red, watery eyes. Fever can persist, rash can last for up to a week, and coughing can last about 10 days. Measles can also cause pneumonia, seizures, brain damage, or death.

Meningococcal Disease (Can be prevented by MCV vaccine)Meningococcal disease is caused by bacteria and is a leading cause of bacterial meningitis (infection around the brain and spinal cord) in children. The bacteria are spread through the exchange of nose and throat droplets, such as when coughing, sneezing or kissing. Symptoms include nausea, vomiting, sensitivity to light, confusion and sleepiness. Meningococcal disease also causes blood infections. About one of every ten people who get the disease dies from it. Survivors of meningococcal disease may lose their arms or legs, become deaf, have problems with their nervous systems, become devel-opmentally disabled, or suffer seizures or strokes.

Mumps (Can be prevented by MMR vaccine)Mumps is an infectious disease caused by the mumps virus, which is spread in the air by a cough or sneeze from an infected person. A child can also get infected with mumps by coming in contact with a contaminated object, like a toy. The mumps virus causes fever, headaches, painful swelling of the salivary glands under the jaw, fever, muscle aches, tiredness, and loss of appetite. Severe complications for children who get mumps are uncommon, but can include meningitis (infection of the cover-ing of the brain and spinal cord), encephalitis (inflammation of the brain), permanent hearing loss, or swelling of the testes, which rarely can lead to sterility in men.

Pertussis (Whooping Cough) (Can be prevented by Tdap vaccine)Pertussis is caused by bacteria spread through direct contact with respiratory droplets when an infected person coughs or sneezes. In the beginning, symptoms of pertussis are similar to the common cold, including runny nose, sneezing, and cough. After 1-2 weeks, pertussis can cause spells of violent coughing and choking, making it hard to breathe, drink, or eat. This cough can last for weeks. Pertussis is most serious for babies, who can get pneumonia, have seizures, become brain damaged, or even die. About two-thirds of children under 1 year of age who get pertussis must be hospitalized.

Pneumococcal Disease (Can be prevented by Pneumococcal vaccine)Pneumonia is an infection of the lungs that can be caused by the bacteria called pneumococcus. This bacteria can cause other types of infections too, such as ear infections, sinus infections, meningitis (infection of the covering around the brain and spinal

cord), bacteremia and sepsis (blood stream infection). Sinus and ear infections are usually mild and are much more common than the more severe forms of pneumococcal disease. However, in some cases pneumococcal disease can be fatal or result in long-term problems, like brain damage, hearing loss and limb loss. Pneumococcal disease spreads when people cough or sneeze. Many people have the bacteria in their nose or throat at one time or another without being ill—this is known as being a carrier.

Polio (Can be prevented by IPV vaccine)Polio is caused by a virus that lives in an infected person’s throat and intestines. It spreads through contact with the feces (stool) of an infected person and through droplets from a sneeze or cough. Symptoms typically include sudden fever, sore throat, headache, muscle weakness, and pain. In about 1% of cases, polio can cause paralysis. Among those who are paralyzed, up to 5% of children may die because they become unable to breathe.

Rubella (German Measles) (Can be prevented by MMR vaccine)Rubella is caused by a virus that is spread through coughing and sneezing. In children rubella usually causes a mild illness with fever, swollen glands, and a rash that lasts about 3 days. Rubella rarely causes serious illness or complications in children, but can be very serious to a baby in the womb. If a pregnant woman is infected, the result to the baby can be devastating, including miscarriage, serious heart defects, mental retardation and loss of hearing and eye sight.

Tetanus (Lockjaw) (Can be prevented by Tdap vaccine)Tetanus is caused by bacteria found in soil. The bacteria enters the body through a wound, such as a deep cut. When people are infected, the bacteria produce a toxin (poison) in the body that causes serious, painful spasms and stiffness of all muscles in the body. This can lead to “locking” of the jaw so a person cannot open his or her mouth, swallow, or breathe. Complete recovery from tetanus can take months. Three of ten people who get tetanus die from the disease.

Varicella (Chickenpox) (Can be prevented by varicella vaccine)Chickenpox is caused by the varicella zoster virus. Chickenpox is very contagious and spreads very easily from infected people. The virus can spread from either a cough, sneeze. It can also spread from the blisters on the skin, either by touching them or by breathing in these viral particles. Typical symptoms of chick-enpox include an itchy rash with blisters, tiredness, headache and fever. Chickenpox is usually mild, but it can lead to severe skin infections, pneumonia, encephalitis (brain swelling), or even death.

If you have any questions about your child’s vaccines, talk to your healthcare provider. Last updated on 02/02/2015 • CS254242-A