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Camper Application
Application Deadline May 15, 2017


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BRIEF OVERVIEW

Camp Brainstorm Mission: To provide a safe, enjoyable, residential camping experience for children with a primary diagnosis of epilepsy, to build self-esteem by promoting self-confidence, competency and social interaction, and to foster independence in a safe environment away from home.

Camp Brainstorm is a 5 day/4 night residential summer camp for children with epilepsy ages 8 to 17 held at Camp Aranzazu in Rockport, Texas.  Often children with epilepsy are denied the privilege of attending summer camp because of their epilepsy, but that is not the case at Camp Brainstorm.  Camp is a place where children are able to try new things in an environment that is safe, encouraging, and supportive.

The support can be found through a group of talented individuals whom volunteer their time and efforts to ensure your camper has the best week of the year.  Our staff is fully trained in seizure first aid and camp safety. With a camper to staff ratio of 4:1, we pride ourselves on these dedicated individuals and their passion for the mission of Camp Brainstorm.

ELIGIBILITY AND CRITERIA

Any child with epilepsy and/or seizure disorder between the ages of 8 and 17 is eligible to apply to attend Camp Brainstorm. Camp Brainstorm is intended for physically abled children that are functioning at a developmentally appropriate level, and do not have severe physical and behavioral problems. Child must have primary diagnosis of epilepsy and be on anti-seizure medications and/or physician approved treatment therapy (i.e. Ketogenic diet, VNS, etc.) Any secondary diagnosis will be evaluated by our Camper Selection Committee.

Eligibility for selection to attend Camp Brainstorm is dependent on completion of all forms, releases, and applications in this packet. All applications are reviewed and campers are selected by the Camper Selection Committee. Campers will be notified by either phone or email of the selection committee’s decision no later than May 19, 2017.

Should any information completed in this application be found to be falsified previous to and/or during the week of camp, the Epilepsy Foundation Central & South Texas reserves the right to deny acceptance and/or send the camper home. (For example, but not limited to: excessive physical limitations, required care that does not reflect our staff ratio, behavior disturbances, etc.).

APPLICATION, DEADLINES AND SUBMISSION INFORMATION

To apply to participate in Camp Brainstorm, the parent/legal guardian must complete all parts of the application by the stated due date:

Part 1: Online Application (complete on or before May 15, 2017)

  • Section 1 - Camper Information
  • Section 2 - Emergency Health Information
  • Section 3 - Health History
  • Section 4 - Camper Care Information
  • Section 5 - Camper Profile
  • Section 6 - Acknowledgement of Behavior Policy


Part 2: Printed Application (Print, Complete, Sign & Return by mail, fax or email on or before May 15, 2017)

  • Camp Brainstorm Consent Form
  • Camper Treatment Consent Form
  • Medication Administration Form
  • Camp Aranzazu Liability, Medical and Photo Release
  • Shot Record (Upload to application or attach to Part 2)
  • Physical Exam Form (Due by 5/31/2017)


 Camp Physical Evaluation Form (Return by mail, email, or fax on or before May 31, 2017)

  • The Camp Brainstorm Physical Exam Form must be completed/signed by a physician 


Campers are encouraged to apply early. Camper space is limited by many factors.  Your child WILL NOT be placed on the camper list until ALL of the requested documents are received. 

For questions, concerns, or if you require assistance with the application contact us at camp@efcst.org or by phone (210) 653-5353, toll free (888) 606-5353. 

The Epilepsy Foun­dation Central & South Texas provides equal opportunity to qualified persons without regard to race, color, creed, sex, or national origin.






Parent/Legal Guardian Information



Emergency Contact Information

In the event we are unable to contact parent/legal guardian in an emergency, we will contact the following persons regarding your child. If parents are out of town during the week of camp, we must have a contact person that can be reached and is within driving distance of Camp Aranzazu.


Health History

Does your child have a history of the following conditions:

Allergies/Immunizations



Immunization Record is required to attend Camp Brainstorm.  

Campers must have had a Tetanus immunization within the last 10 years to attend Camp Brainstorm.  Please list date of last Tetanus below and attach camper's current shot record.  Shot record may be uploaded or returned with printed section of the application. 
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Seizure Summary





Camper Care Information

Please answer all questions as thoroughly as possible so that we can best care for your child while at camp.

Note: Camp Brainstorm is not staffed to care for children with severe emotional/behavioral problems or for children that require one on one care. 

Camper Profile

(This section should be completed by the camper.)

 We would like to know a little bit about each camper before he/she gets to camp. Please have your camper answer the following questions; this information will be provided to their counselor.

 


Acknowledgement of Behavior Policy

Please review the behavior policy with your child.

Policy:  Management of camper behavior problems at Camp Brainstorm.

Objectives: Provide a quality experience for all campers and volunteers. Decrease the risk of injury to campers and staff. Outline steps for management of extreme behavior problems.

Implementation:
The staff may identify problem behavior as conduct that is disruptive to others at camp or appears harmful to other campers. The following lists specific examples of those behaviors, followed by intervention the staff may take to provide a solution to the problem in order to reach the given objectives.

Examples of Minor Problems:
Teasing, calling names, talking back to staff, failure to cooperate, speaking out of turn, interrupting.

Examples of Major Problems:
Kicking, hitting, biting, bullying, throwing things, spitting, taking other’s belongings, pushing etc.

Exceptions and Disclaimer:
The following course of action could be bypassed in the event of severe behavioral, emotional, or physical disturbances per discretion of the Camp Director. Examples of such behavioral disturbances include but are not limited to: threatening a camper/staff member, physically harming anyone, in any of these cases, the Director has the authority to send the camper home.

Strike I:
Intervening Staff: Cabin Counselors
Course of Action: Call the behavior to the camper’s attention. Inform the camper of the consequences, if the behavior continues (i.e., time out). Redirect the camper’s attention.

Strike II:
Intervening Staff: Cabin Counselors, Assistant Directors (AD), Camp Director
Course of Action: Possible sit-out. Staff explains to the camper that because s/he has continued the behavior, s/he will sit out of the group for several minutes or the reminder of the activity. A call will be made to the child’s parent or legal guardian. Parent/Guardian will be asked for assistance in redirecting child’s undesirable behavior.

Strike III:
Intervening Staff: Camp Director and Epilepsy Foundation Staff
Course of Action: Child will be sent home. A child is given two opportunities for behavior modification. If the inappropriate behavior is repeated after the call home, the parent or legal guardian will be called to have the child picked up. If the parent or legal guardian cannot be reached within 4-6 hours, the emergency contact will be called. THE CHILD MUST BE PICKED UP WITHIN 12 HOURS AT FAMILY’S EXPENSE.