challenge change live B

Transcription

1 challenge change live B DATES: October 10-12, 2014 Applications Due by September 2nd AGES: The Experience The Generation IX Project was designed for you. You re looking for the next adventure, the next challenge. You re craving an experience beyond the classroom and the routine. There are others like you, teens and young adults that will band together to learn how to do more, learn more, experience more, and be more than they thought possible. This is your chance to do something profoundly different from the everyday. Your endeavor starts with a flight to Portland Oregon, where a team of college-aged (and maybe a little bit older) program mentors will meet you. They will be your guides through a weekend of high ropes challenge course experiences, living within a temperate rainforest, and making connections with other participants living with hemophilia B. The Generation IX Experience is a brand new mentorship program for young people living with hemophilia B. Young adult mentors will participate in a cutting edge leadership training before guiding teens through a powerful weekend full of challenges and fun in a stately camp facility outside of Portland, Oregon. Since teens are in the fastest changing age group in the bleeding disorder community, part of this weekend will entail learning skills and developing support from others in leading the highest quality of life possible. Teens will learn about themselves, their potential, and how to work in a group from mentors, and a professional instructor team with years of experience in the outdoor education and bleeding disorder fields. The Leadership Pat Big Dog Torrey is designing and implementing this program through a partnership with the Coalition for Hemophilia B thanks to the generous support of Emergent. Patrick Torrey has been designing and delivering innovative experiential education programs and trainings for over 15 years. Pat started and runs Physis. Physis offers unconventional, adaptable, relationship-centered adventure education programs that teach those with chronic medical conditions how to lead rock-star lives. He challenges and inspires people to explore outside of their perceived limits and strive for excellence in their lives. He and his staff run trainings and consult within the bleeding disorder community for camps, foundations, and boards. Physis has been running some of the most successful, fun, and sought after programs in the bleeding disorder community for close to a decade. The Coalition for Hemophilia B Team Wayne Cook, Kim Phelan and Dr. David Clark each bring over 20 years experience in hemophilia B. We have been empowering people with hemophilia B and their families to ensure they have the best quality of life possible. We offer a family-oriented hands on approach. We provide timely Information so members and their families are well informed. We believe education is power and provide several outreach programs such as our factor nine newsletter, factor nine family meetings, retreats and yearly symposiums. The Coalition brings together some of the most dedicated professionals in the hemophilia community and we continually challenge ourselves to grow to meet the needs of the community. The Coalition for Hemophilia B was founded by John and Joyce Taylor after their son was diagnosed with severe hemophilia B. They recognized a need for an organization to serve this community. The Destination The Generation IX Experience will take place at YMCA Camp Collins just outside of Portland, Oregon. Collins is home to villages of out of the ordinary cabins and one of the nations most diverse high ropes challenge courses. Mentors and Teens will spend the weekend in Treetops Village, a network of cabins perched on stilts in the forest canopy, connected by a walkway overlooking the forest. But these are not your average rustic cabins. Each dwelling comes equipped with heated floors, bathrooms, and individual bunk shelves, windows, outlets, and lights. The cabins are not far from the dining hall where the group will eat three meals a day with a daily salad bar. The camp sits beside the Sandy River (known for occasional salmon spotting), and every destination is just a forest trail walk away.

2 Schedule Friday: Teens Fly to the Portland Oregon Airport Mentors Arrive Early to the Portland Airport FAQ s Trip Cost Per Person: Thanks to the generosity of Emergent, the Generation IX Project is provided at no cost to participants. Saturday: Sunday: Mentors Greet Teens and Run Programs at the Airport While Others Arrive Teens, Mentors, and Staff Return to Camp Collins Together Teen Retreat Component Begins in the Late Afternoon Teen Retreat Continues with this Full Blown Programming Day Adventure Based Activities at the Forefront of the Program Teen Retreat Concludes in the Morning Mentors and Teens Travel Back to the Portland Airport Mentors Return Teens to Flights Mentors Run Programming for Later Departing Teens at the Airport Mentors Depart for Personal Flights Participants: Mentors: years old. Teens: years old. (All participants should be affected by Hemophilia B) Weather: The Generation IX Project is hosted in an awe inspiring temperate rain forest in Oregon. With rich green hues, and massive trees, come cool and sometimes wet weather is to be expected. Participants should come prepared for temperatures from low 50s to mid 70s at this time of year. Cuisine: YMCA Camp Collins offers wholesome meals three times a day. Two meals come with a salad bar. Program Acceptance: There are a limited number of spaces in this program. After your application has been reviewed you will be notified of your acceptance into the program by Kim Phelan by September 15, How do I apply? Please fill out the accompanying Teen Application form and send in by September 2nd. Make sure that you re filling out the form for your correct group, either teens or mentors. Forms received after this time will be subject to availability. Please contact us with any questions about the application. Mail/Fax/ Form To: Kim Phelan The Coalition for Hemophilia B 825 Third Avenue, 2nd Floor New York, NY Office: (212) Cell: (917) Fax: (212) hemob@ix.netcom.com Information provided to the Coalition for Hemophilia B for the purpose of participating in the Generation IX Project will not come back to or be shared with the project sponsor, Emergent BioSolutions. IXI

3 teen Application The Coalition for Hemophilia B hemob@ix.netcom.com AGE AT THE TIME OF THE PROGRAM: FIRST NAME INITIAL LAST NAME SUFFIX HOME ADDRESS CITY STATE ZIP CODE COUNTRY DAYTIME PHONE NUMBER PARENT/GUARDIAN NAME HOME PHONE CELL PHONE EMERGENCY CONTACT (other than parent/guardian) RELATIONSHIP HOME PHONE ALTERNATE PHONE LOCAL CHAPTER/ASSOCIATION NAME OR AFFILIATION LOCAL HEMOPHILIA TREATMENT CENTER Any food allergies: r YES r NO If yes, please list all your food allergies Do you require any dietary accommodations (vegetarian, vegan, GF, celiac, etc) r YES r NO Please list here: How did you hear about the Generation IX Project? r My local chapter r HTC r Annual meeting r Sibling/Friend r Other: Travel Arrangements I will travel by: r AIR r CAR r Hot Air Balloon r I will be arriving Friday, October 10, 2014 and departing Sunday, October 12, 2014 r I m interested in attending the Generation IX Project retreat, but I have a question about the dates. I will contact Kim Phelan A.S.A.P. If I am unable to do that at this time, I will submit this application, with this box checked, and expect a call soon. Do you have any physical limitations that you would like to make us aware of? Do you require any special accommodations? r YES r NO If YES, please elaborate:

4 Let us get to know you Take just a few minutes and please answer the following questions in the space provided or attach a separate document if you prefer. Answering these questions will help us shape the program to specifically work for you. Why do you want to participant in the Generation IX Project Retreat in Oregon? What do you want to get out of the Oregon retreat? (Consider leadership skills, interpersonal skills, fun, relationships, travel opportunity, connections, etc ) Is there anything else you think we should know?

5 Roles And Guidelines Will fly to Portland Oregon (with a possible layover) to meet Mentors. Participate fully in the Generation IX Project. (You will have the opportunity to choose a level of challenge that you think and feel will help you grow and develop. Please talk with a Mentor and/or a member of the Leadership Team if you meet a challenge that you feel is outside of your scope of your abilities). Live with a group of other Project participants in comfortable camp cabins with shared living spaces Requirements Be between the ages of 14 and 17 years old Be a male with a Hemophilia B Diagnosis Must follow all directions and expectations of Leadership and Instruction Team Must demonstrate respect for mentors, program leadership, other teens, and self Adhere to a schedule of fun and engaging activities throughout the weekend. The program activities may include participating in a high ropes challenge course, interactive teambuilding games, interacting with other teens and college-plus aged mentors. Appear in The Generation IX Project video documentary. These short documentary pieces will highlight the benefits and insights of the program and will be shared with the larger bleeding disorder community and beyond. Must follow all guidelines and expectations of the host site, YMCA Camp Collins Bring an appropriate amount of Factor, supplies, and other necessary medications for the duration of their stay at the Oregon Retreat There are a limited number of spaces in this program. After your application has been reviewed you will be notified of your acceptance into the program by Kim Phelan by September 15, Personal Commitment Statement By signing below, I agree to fulfill all expectations listed above for a Teen participant applicant for the Generation IX Project. I will participate to the best of my ability and conduct myself to encourage and enable the success of all other participants and program staff. I will immediately contact program leadership if, for any reason, I am unable to follow through with the above expectations. Additionally, by signing below, I verify that all information provided above is true. Teen Participant Signature Date Guardian Commitment Statement By signing below, as the legal guardian of the aforementioned Generation IX Teen Participant, I acknowledge that my child or ward is participating in the Generation IX Project retreat in Oregon, and give permission for them to participate in all program activities including the high ropes challenge course, riding in a vehicle to and from YMCA Camp Collins, possibly flying to and from Portland Oregon with possible layovers, living in an overnight camp with other program participants, and all other activities that the program entails. Additionally, by signing below, I give permission to the Generation IX Project leadership to contact my child and me with program updates via my account. Also, by signing below I commit to helping support my child in preparing for the Generation IX Project as well as support them in any additional challenges that they receive during the retreat to complete at home and/or challenges that are given via online communication after the Oregon Retreat event. Additionally, I verify that the information provided above is true. Participant Parent or Legal Guardian Print Name Participant Parent or Legal Guardian Signature Date IXI