Home

Campers

Staff

Donate

About Camp

Links

  

Summer 2008 Pre-registration

To pre-register for camp, please fill out the following form. Required fields are marked with *

Camp Session*
Camper First Name*
Camper Last Name*
Sex*
Birthday*
Camper Age at Camp*
Fast-acting insulin*  Humalog  Novolog  Apidra
Form*  vial  cartridge  pen
Short-acting insulin  Humalin R  Novolin R
Form  vial  cartridge  pen
Intermediate-acting insulin  Humalin N  Novolin N
Form  vial  cartridge  pen
Long-acting insulin  Levemir  Lantus
Form  vial  cartridge  pen
Camper on a pump?* No
Yes, Type 
T-shirt Size*
Diabetes Type*
Home Address*
Home City*
Home State*
Home Zip Code*
Home Phone*
Parent's Email*
Father's First Name
Father's Last Name
Father's Cell Phone
Father's Work Phone
Mother's First Name
Mother's Last Name
Mother's Cell Phone
Mother's Work Phone

Camp Hertko Hollow
101 Locust St.
Des Moines, IA 50309
Ann Wolf, Executive Director
515-471-8523
a.wolf@camphertkohollow.com

Vivian Murray, Camp Director
352-750-6759 or 888-437-8652 (Toll free)
v.murray@camphertkohollow.com

Camp Hertko Hollow, Inc. is the organization that operates the camp and is solely responsible for it's actions.  It is not affiliated with any national diabetes organization

Camp Hertko Hollow is an Iowa Non-Profit Corporation

Camp Hertko Hollow is an ACA-Accredited Camp