Camper Forms

The following forms will also be mailed to you with the parent packet prior to the start of camp, but are also available for download:


1) The 2017 Physician's Report needs to be completed and signed by your child's physician or endocrinologist and submitted to the Camp Hertko Hollow office by June 16, 2017.  Click here to download the form.


2) Parents are asked to fill out a “daily log” for the week prior to attending camp.  Please record blood sugars, insulin doses and exercise level.  Simply fill out the side for the week labeled “HOME” plus Sunday morning on the camp side.  If your camper uses an insulin pump click here to download the form, or here if your camper uses syringes.  Please plan on bringing this completed form with you to the first day of camp.


3) Diabetes Camp Fundraiser contest (OPTIONAL): Want to help us raise funds that will allow more children to attend camp?  It is Camp Hertko Hollow’s philosophy that a family’s financial situation should never get in the way of their child benefitting from a Camp Hertko Hollow experience. You can help Camp Hertko Hollow by obtaining donations that will directly benefit campers who cannot afford to pay the full cost of camp. Please pass this form around at work, church, your neighborhood, etc. and ask friends and family to help your camper in this adventure.   If you are interested in participating please bring your fundraising money, and names of the donors with you to turn in at camp registration.  Click here to download more information.


4)  Important date:  All payments, requests for financial aid and sponsorship payments must be received by 6/1/2017.