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Campership Application

The Great Lakes Hemophilia Foundation (GLHF) offers camperships to all children and youth with bleeding disorders. A GLHF Campership will support the registration and camp fees for qualified children attending either Bold Eagle or Eagle Outpost Camp in Michigan, Camp Courage North in Minnesota or Camp Warren Jyrch in Illinois. To apply for a GLHF Campership, please attach a copy of your camp registration form (if available) to the completed form below and return the form(s)  to the GLHF office.

The original camp registration form MUST be sent directly to the camp the child will be attending.

The application deadline for camperships is May 14, 2010. The campership money will be sent directly to the camp indicated below upon notification of enrollment.

 If you have any questions please contact Karin Daniels at 414-257-0200 or toll free at 888-797-4543.

To apply on-line please fill out all of the following information and submit.*

 

Camper's Name   Camper's Birth Date

Camper's Diagnosis:          Hemophilia A/Factor VII Deficiency            Hemophilia B/Factor IX Deficiency
                                                        (check one)     Mild        Moderate        Severe

                                      von Willebrand Disease - Severe        von Willebrand Disease - Other than severe

                                                Other Bleeding Disorder:

Parent/Guardian Name     Email

Address    City   State   Zip

Telephone

Camp Attending:  Camp Warren Jyrch

                         Camp Bold Eagle (11-13 yrs)           Camp Bold Eagle (6-10 yrs)

                         Eagles Outpost                             Camp Courage North

Dates of Camp:

 

  

*Note:  This is not a secure registration

 

 

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Great Lakes Hemophilia Foundation

  638 N. 18th Street, Suite 108
Milwaukee, WI
53233
E-mail:
  info@glhf.org

Phone: (414) 257-0200
Toll free: 
(888) 797-4543
Fax: (414) 257-1225

 


Copyright © 1999, Great Lakes Hemophilia Foundation. All rights reserved.  Last updated Monday August 30, 2010.