has two 1-week sessions for kids who have diabetes. camp life at diabetes camp! can YOU make in the lives of children with diabetes while at camp? …
__ IOWAS CAMP FOR YOUTH WITH DIABETES___________
Vivian: 352-750-6759 or 888-437-8652
Office: 101 Locust Street, Des Moines, IA 50309
Web site: wwwCampHertkoHollowcom
E-Mail: CampHertkoHollow@aolcom
TO: All potential staff members
January 2008
Its time to think about joining the staff of CAMP HERTKO HOLLOW this
summer We need physicians, nurses, dietitians, dietetic interns, nursing
students, med students, pharmacy students, and counselors who have
diabetes Camp Hertko Hollow has two 1-week sessions for kids who have
diabetes It has been successful because of our dedicated volunteers who
have become our Camp Family, but we also need new, energetic bodies
Every year I am awed by the dedication of our staff members who return year
after year who are ABSOLUTELY TREMENDOUS As you know, we all receive far
more in return - the wisdom and personal gratification from spending a week
in the woods with these campers When we come together each summer
friendships are renewed within minutes, we are there for a purpose, the
kids are wonderful, and
its all very worthwhile
Medical staff members live in cabins with 8-10 campers, a YMCA counselor,
and a diabetes counselor Campers do their finger stick blood tests in
their own cabin and then go to the Shoot Em Up Shack for insulin
injections Of course we have a wide variety of insulins and schedules, so
there are kids taking insulin before each meal and/or bedtime Last year
we had 138 campers on insulin pumps and expect more this year, so these
kids need to change their sites every few days Schedules are made up
for Health Lodge coverage for the nurses and nursing students Pharmacy
students rotate on med cart duty prior to each meal
My goal is to have the staff selected by April 15th Then Ill have time
to conduct background and reference checks All staff members are required
to attend Orientation Day on the Saturday before the campers arrive This
training is part of our American Camp Association requirements and is
essential for the 60 staff members to get acquainted learn expectations
and procedures
Have you viewed our web site? wwwCampHertkoHollowcom
Any questions? Send an E-Mail to: CampHertkoHollow@aolcom
The web site has photos,
camper and staff application forms, financial aid
information, camp history, and more about camp We will also provide pre-
camp STAFF TRAINING MODULES on our web site A packet of information is
sent to all campers and staff in early June to give the final details such
as what to bring and directions to the camp
Word of mouth is our best advertisement for Camp Hertko Hollow Anything
you can do to tell potential campers and staff about the opportunity is
greatly appreciated We are not yet reaching all minorities and newly
diagnosed children We especially want to contact children who have never
attended camp in the past I will be contacting former campers who are
still age eligible If a family is not able to afford the camp fee, be
sure to tell them that camperships are available Transportation to camp
has been another concern for some families - there are solutions We want
to serve all youth in Iowa who have diabetes Non-diabetic siblings are
welcomed to come to camp for one year - but only if space is available
One sibling per family may also apply for financial aid
The camp is operated by organization called Camp Hertko Hollow, Inc We
have our Articles of
Incorporation, Bylaws, Board of Directors, and
501c 3 non-profit status, so all donations are tax deductible Every
little bit helps Donations to sponsor a child can be sent to Camp Hertko
Hollow, 101 Locust St, Des Moines, IA 50309 or use a credit card by
calling the office at 515-471-8523 Dr Hertko, Executive Director Ann Wolf,
and her assistant Deb Holwegner are very busy contacting organizations and
foundations for large donations to benefit camp Please ask some local
service clubs in your area to sponsor a child for this summer We have a
camp video and a camp DVD available to loan to groups - just contact me
I certainly hope that you will be able to join the staff of Camp Hertko
Hollow this summer
Sincerely,
Vivian Murray, Camp Director
Camp Hertko Hollow Staff Application
Please print
New applicant ___ Former staff member ____ Date of Application:
_______ Social Security Number: _________________
Name: ______________________________________________ E-Mail:
___________________________________________
Permanent Address:
______________________________________ College
address:___________________________________
City/St/Zip:
_____________________________________________City/State/Zip:________________
_____________________
Mail should be sent to: Check One _____Permanent Address ____
College Address until what date? _______
Current Phone Number: _____ _________________ Work Phone Number:
__________________What hours?_______
Cell Phone: _____ _________________ FAX: ____ ___________________
What camp position are you seeking? ___ Counselor ___
Medical Student ___ Dietetic Intern
___ Physician ___ Nursing
Student ___ Pharmacist
Other ______________________ ___ Nurse ___ Dietitian
___ Pharmacy Student
T-shirt size: ___Small ___Medium ___ Large ___ X-large ___XX-
Large
Session you wish to volunteer:
____ Teen Camp: June 29- July 5, 2008 6-12th grades
____ Both sessions
____ Kids Camp: July 6-12, 2008 K-1st grades
____ Wherever needed
_____ Family Camp - April 4-5,
2008
Age of Campers with whom you would prefer to work: ___ 6-8 ___ 9-11
___ 12-14 ___ 15-18 ___ No Preference
Are you at least 18 years of age? ___ YES ___ NO Birthday:
________________ Camp Staff must be age 18 or over
Month-day
Do you have any physical or mental disabilities that might prevent you from
performing the essential functions of the position for which you are
applying? ___ YES ___ NO If YES, do you have specific
suggestions as to how we could accommodate your mental or physical
disability?_________________________________________________________________
___________
Can you function on limited sleep?_______ A reality of camp life at
diabetes camp
Do you have any dietary restrictions such a low cholesterol, vegetarian, or
food allergies? _____NO ____YES List brand names that you prefer for
special diet
____________________________________________________________________________
________________________________
Education: University Degrees received
____________________________________________________________________
Major Field of study ____________________________
Additional
Professional Credentials that you hold: CDE; RPh; RD; RN; MD,
DO, FNP, etc _____________________________
Current employer: ___________________________________ Supervisor:
___________________________________
Occupation: _____________________ Dates of employment: _______________
Supervisors phone: _____________________
List relevant camp, volunteer, or child care experience:
|Dates | | | | |
|Camp or | | | | |
|Organizati| | | | |
|on | | | | |
|Supervisor| | | | |
|Address | | | | |
| | | | | |
|Phone | | | | |
|Position | | | | |
|Held |
| | | |
Staff
App - page 2
New Applicants Only
References Give names/addresses of 3 persons not related to you who have
knowledge of your character, experience, and ability
|Name | | | |
|Address | | | |
| | | | |
|Day Phone/ |________________________|______________________|____________________|
|Evening Phone |____ |__ |___ |
What contributions can YOU make in the lives of children with diabetes
while at camp?
____________________________________________________________________________
_______________________
Rate Your Knowledge: 0 none 2 some 3 can assist 4
well versed willing to teach topic to campers
____Eatiing out ____Exercise ____Insulin
____Behavior Management ____HbA1c ____Insulin Pumps
____Blood
Testing ____Hyperglycemia
____Ketoacidosis
____Carb Counting ____Hypoglycemia ____Nutrition
___ Dealing with Peer Pressure ____Injections
____Sick Days
___Diabetes Complications ____Injection Site Rotation ____Weight
Control
Please list other topics you wish to teach:
______________________________________________________________________
____________________________________________________________________________
____________________________
Im interesting in helping with : ____Daily newsletter ___ Crafts
___Office work ___ Skits ___ Leading Songs
List other talents:
____________________________________________________________________________
______________
Have you ever attended a diabetes camp?______ Explain:
_________________________________________________________
DO YOU HAVE DIABETES? Circle: Yes or No Describe Pump, Insulin
Pen, and Types of insulin that you use:
____________________________________________________________________________
___________
Provide other pertinent information regarding your application to be a
staff member at Camp Hertko Hollow:
Mandatory for All Physicians and
Nurses New and Returning
What license do you hold?
_____________________________________________________________
What states are you licensed in?
________________________________________________________
Please attach a copy of your current license for Iowa or documentation
Has your license ever been revoked? _____ YES _____ NO
If YES, please explain:
____________________________________________________________________________
__________________
Have you ever been accused of, convicted of, or had deferred adjudication
of medical malpractice? ___YES ___NO
If YES, please explain:
____________________________________________________________________________
__________________
Do you have malpractice insurance covering your service at camp? _____ YES
_____ NO
I authorize investigation of all statements herein and release Camp Hertko
Hollow, Inc and all others from liability in connection with same I
understand that I will be a volunteer and receive no compensation for
services I understand that untrue, misleading or omitted information
herein may result in dismissal, regardless of the time of discovery
__________________________________ __________ Mail to:
Vivian
Murray, Camp Director
Applicants Signature Date
CAMP HERTKO HOLLOW
101 Locust St
Questions? Call 888-437-8652 or 352-750-6759 or 352-406-2962 cell
Des Moines, IA 50309
