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CampMed
Application
2015
INSTRUCTIONS FOR COMPLETING THE APPLICATION:
1. Download the application. Students who wish to participate should have an interest in a healthcare
career.
2. Type in the gray boxes on the application and save. (If you need to print and handwrite, that is okay.).
3. Print the form, sign the guidelines, and send to the address below. Applications sent via email will not
be accepted.
4. An application fee of $50.00 must be included with the application. Scholarships may be awarded
if needed. Contact the camp director.
Please make checks payable to Virginia Hospital Center. Memo: CampMed.
5.
Mail to:
Grace Greenan, Executive Offices
ATTN: CampMed, Kelley Arllen Box # 20
Virginia Hospital Center
1701 N. George Mason Dr.
Arlington, VA 22205
OR
Hand Carry to the Executive Offices:
Envelope should read: ATTN: CampMed, Kelley Arllen
Nursing Administration Box # 20
Directions: Turn into the hospital at the traffic light and make an immediate right, follow
the road until you are in front of the modern looking 1625 entrance. Make a left into the
circular drive and put your flashers on. 1625 is the main entrance and has a revolving
door, it technically faces 16th street. Once inside the lobby you will see a Starbucks Stand
on the right. The Executive Offices are located directly above the Starbucks. Take the
grand staircase or the elevator to the 1st floor. Walk to the Executive Office, and go
through the double glass door. Give your envelope to the receptionist.
Applications are processed as they arrive and must be complete before they can be considered –
including the application, enrollment fee, and signatures.
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CampMed
Application
2015
Please Retain This Page for Your Information:
This program has limited enrollment, a waitlist will be created once capacity is reached. Applications are
processed as they arrive. Notification of enrollment will be made by email.
Once accepted in to CampMed, a forms packet will be emailed and must be completed by May 31. The forms
to complete will include proof of a recent physical (within the last year) including TB screening and
immunization status; medication administration paperwork if needed; and transportation permission forms.
Additionally, the student will need to come to the hospital to create a hospital photo ID before camp. A “ticket”
to get the ID will be with the forms packet with additional information. The ID office is open Monday-Friday
from 7am to 4pm, closed on July 3.
CampMed Dates:
Session I: July 27 to 31 (rising 6th and 7th grades ONLY)
Session II: August 10 to 14 (rising 8th and 9th grades ONLY)
Camp hours are 8:30am to 3:30pm.
Campers must be dropped off and picked up on time. Before and after care is NOT available.
CampMed Orientation Dates. Students AND a guardian must attend one orientation session:
June 1 at 7pm
June 10 at 7pm
If you have questions regarding CampMed please contact the Camp Director, Kelley Arllen. Email is
best: karllen@virginiahospitalcenter.com Phone: 703.558.8526
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CampMed
Application
2015
Student’s Legal First Name:
Last Name:
Please indicate if the student goes by a different name or a preferred nickname:
Street Address:
City:
State:
Zip Code:
Family Telephone Number:
Parent/Guardian name:
Parent/Guardian email (this is how we will notify you of enrollment):
Student’s grade for September 2015:
Have you previously attended CampMed?
NO
YES* If yes, when?
(*Preference will be given to first time applicants. Decisions on returning campers will be made after May 31.)
Please check ONE session. Camp hours are 8:30am to 3:30pm. Students MUST attend all five full days
of camp:
Session I: July 27 to 31 (rising 6th and 7th grades ONLY)
Session II: August 10 to 14 (rising 8th and 9th grades ONLY)
In order to participate in camp, attending an orientation session is REQUIRED. Orientation must be
attended by the student and a guardian. The session will end by 8:30pm. Please check ONE orientation
session:
Monday, June 1 at 7pm
Wednesday, June 10 at 7pm
Application fee of $50.00 must be attached. Please make checks payable to Virginia Hospital Center.
Memo: Camp Med
Please, briefly, describe the student’s interest in healthcare:
Page 4 of 4
CampMed
Application
2015
Guidelines for Campers
I agree to the following guidelines:

Eat a hearty breakfast before coming to camp each day.

Arrive on time each day. I understand that I have agreed to be present on all five days, for the
entire day. Camp begins at 8:30 AM.

Dress appropriately; including wearing camp issued shirt and ID badge each day. Guidelines for
attire will be addressed further at orientation.

Bring camp issued bag each day.

Leave all valuables at home, including portable music devices or electronic games.

Cell phones are discouraged, but if necessary, the phone must be on the silent setting and may not
be visible during camp hours.

Respect and follow the directions of camp staff, volunteers, and hospital employees.

Be respectful and courteous toward hospital patients and visitors. Please be quiet when in patient
care areas.

Be mindful of patient privacy and confidentiality. Further guidelines will be given at orientation.

Participate and have fun!
These guidelines are for the safety, privacy, and well-being of patients, campers, and staff.
Student Signature: ______________________________________________________
Guardian Signature: ________________________________________________________