Camper Registration

COVID-19:
We will follow the CDC guidance for day camps during Camp Trios.  We will send an email update the week before camp with the latest requirements.

WHO:           Children ages 6 to 14 with type 1 diabetes

WHAT:         Learning & having fun!

WHERE:       Southridge Sports Complex, (Tri-City Court Club)
                       2901 Southridge Blvd, Kennewick, WA 99337

WHEN:         Tuesday July 20th        8:30 am to 4:30 pm
                       Wednesday July 21st   8:30 am to 4:30 pm
                       Thursday July 22nd     8:30 am to 4:30 pm

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* 1. Registration Checklist
All checklist items are due June 30, 2021

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* 2. Camper Registration Information

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* 3. Sex

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* 4. Parent/Guardian

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* 5. Other person(s) authorized to pick child up or contact in case of emergency

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* 6. Insurance information:
In the event of any need for medical care outside of the camp setting, insurance information for your child may be needed. Please complete the following:

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* 7. Tell us about your child:
Would you describe the camper as one who (check all that apply)

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* 8. Does your child get along with others?

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* 9. Is your child excited about coming to camp?

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* 10. Can your child swim?

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* 11. Is there any information that would help us ensure your child has the best camp experience possible?

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* 12. T-Shirt Size:

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* 13. Medical Information:
Does your child use an insulin pump?

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* 14. If yes, what brand and model:

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* 15. Does your child usually give own insulin injections or use pump without assistance?

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* 16. List name of insulin used:

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* 17. Carbohydrate ratios:

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* 18. Correction Factors:

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* 19. Blood glucose targets for correction factors:

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* 20. Does your child bolus before or after meals?

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* 21. Will your child need help with blood glucose tests?

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* 22. Has your child ever had seizures?

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* 23. Does your child recognize signs of low blood sugar?

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* 24. What are the usual symptoms of low blood sugar for your child?

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* 25. Will your child need to take any other medication besides insulin during camp hours?

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* 26. Please list any other medications, dosage, & schedule for your child:

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* 27. Please list specific accommodations needed or other health concerns we should be aware of:

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* 28. Camp Menu
July 20:     Subway
July 21:     Costa Vida
July 22:     BBQ

*menu will have gluten free options

NOTE:  Two snacks a day and all entrees will include fruit, vegetable and water

Food allergies or special accommodations to menu:

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* 29. CONSENT:
I hereby give my consent for adjusting insulin dose, injecting insulin, performing blood tests, or any medical care deemed necessary by camp physicians, nurses and dietitians. I will not hold liable Camp Trios, Trios Health or any individual associated with the Camp, for accidental injury or illness resulting from this camper’s attendance and camp activities. I understand a camp setting is different than the home setting and management of my child’s diabetes schedule, while medically supervised at camp, will need to be flexible.

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* 30. Camp Trios publicity Release Form:
Trios Health, and/or the local news media (i.e., TV, newspaper, radio) has my permission to take my child's picture, and/or interview my child, for local news stories while my child is a participant of Camp Trios.

I understand that I may or may not appear, or be mentioned, in said news story and require no financial or other remuneration for this. I understand that I have the right to rescind during taping or filming, not after the product is completed.        

Release applies to dates of Camp Trios only – July 20, 21 and 22, 2021
Trios Health staff will oversee all interviews and photos.                                  

Camp Trios is committed to making a difference in the lives of children with diabetes, ensuring that they have the opportunity to live a healthy life and enjoy a safe environment to gather while learning to be self-disciplined and responsible.  
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