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Medical Staff Camp Candlelight 2018 Application

Camp Candlelight Dates:
Saturday, June 2nd (Optional) – Saturday, June 9th 2018  

Location: Sky-Y Camp | 5725 S. Senator Hwy. | Prescott, AZ 86303


Camp Candlelight is one of the most cherished programs offered by the Epilepsy Foundation of Arizona and one we believe can be a life-changing experience for a child, and families, living with epilepsy. We are excited you are interested in applying to be a part of this opportunity. Camp Candlelight provides children ages eight to seventeen with a unique camping experience that combines traditional camp activities with specialized sessions that teach the campers about their seizures and gives them valuable tips for dealing with the challenges that epilepsy may present. Camp Candlelight is designed to be an educational experience, as well as fun. Campers are taught about seizures, medication and socialization from camp counselors and staff, many of whom have epilepsy, have a family member with epilepsy, or a background in healthcare.

Below you’ll find the downloadable PDF for the 2018 Camp Candlelight Med Staff App. This PDF has built-in form fields for you to complete. If your browser doesn’t support this, please download the PDF to your computer and open to fill in the fields.

VERY IMPORTANT:

1. BEFORE FILLING OUT, DOWNLOAD AND SAVE ONTO DESKTOP.
2. UPON COMPLETION ENSURE YOU “SAVE AS” UNDER A DIFFERENT FILE
NAME OR NONE OF THE COMPLETED FORM FIELDS WILL SAVE AND ALL
WILL APPEAR BLANK.

2018 MED STAFF APP

APPLICATION DEADLINE: Friday, April 27, 2018

Med Staff Application Checklist:

PART 1: GENERAL INFORMATION
PART 2: MEDICAL STAFF ASSESSMENT QUESTIONS/OTHER INFO.
PART 3: PROFESSIONAL INFORMATION
CPR CARD/CERT. COPY (FRONT/BACK)
PART 4: MEDICAL INFORMATION
PART 5: PART 5: STAFF I.C.E. INFO
PART 6: RELEASE OF CLAIMS AND CONSENT

MAIL TO:
Epilepsy Foundation of Arizona
Attn: Camp Candlelight
3620 N. 4th Ave. Rm. #228
Phoenix, Arizona 85013

OR SCAN & EMAIL TO:
E-mail: info@epilepsyaz.org
Subject: 2018 Camp Med Staff App

***ATTN: WE DO NOT HAVE A FAX MACHINE***