Join our 2022 Spring Campference for Young People Living with HIV

Are you a young person, ages 18-29, living with HIV and looking for an opportunity to meet new friends living with the same medical condition? Next Step is hosting a FREE 3-day virtual Spring Campference from Thursday, March 10th to Saturday, March 12th. Join us for three days of fun times, important discussions, and personal growth!

Here is what you can expect at our Spring 2022 Campference:

You’ll meet with peers living with a similar medical condition.
You can participate in our music therapy and expressive art projects.
You can learn important life skills through various youth-led workshops.
Did we mention the fun games and activities?!

Questions?

Email Kepler Jeudy, Next Step Program Director, if you have questions about joining this Spring Campference: kepler@nextstepnet.org

Apply to our Spring 2022 Weekend Campference

Name*
First Last
Nickname or Preferred Name
Have you been on a Next Step Campference before?*
- Yes
- No
How did you hear about the Next Step campference?*
- Website (personally googled and found us)
- Another Participant
- Medical Staff
- Other
If "other" or "medical staff," please tell us how and include the name, position and hospital of the medical staff who referred you:*
Your Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Alternate Phone
Email*
Preferred mode of contact?*
- Email
- Cell Phone (Call)
- Cell Phone (Text)
Current Occupation
Employer or School
Age
Birthday
MM slash DD slash YYYY
Gender
Hospital or Clinic where you receive medical care?
What do you hope to get out of the Next Step campference experience?
What topic(s) do you most want to learn about at Campference?
PARENT/GUARDIAN OR EMERGENCY CONTACT
Name*
First Last
Relationship
Phone
Email
Medical Overview
Diagnosis
Date of Diagnosis
MM slash DD slash YYYY
Are you on active Treatment?
- Yes
- No
Food Allergies & Reactions
Environmental Allergies (bee, latex, etc) & Reactions
Do you carry an Epi-Pen?
- Yes
- No
Are there are any special accommodations you would need (dietary, mobility, equipment, etc.)? Please explain:
Are there any activity limitations?
Please list any medications you take, and how often.
Please take a moment to describe what symptoms you display if you’ve overextended yourself or are starting to get sick. How can we best support you in such a situation?
INSURANCE INFORMATION
(Please bring your insurance card to the program)
Insurance Co:
Policy #:
Name of Insured:
First Last
Prescription
Plan #:
Telephone #:
Over the Counter Medications: I—or my child, if under the age of 18—has permission to take over-the-counter medication, for the dosage amount suggested by the pharmaceutical maker, if feeling unwell due to symptoms such as headache or stomachache. Please check appropriate boxes and provide your signature below:
I—or my child, if under the age of 18—may take over-the-counter medication that I brought:*
- Yes
- No
I—or my child, if under the age of 18—may take OTC medication provided by a staff person:*
- Yes
- No
I—or my child, if under the age of 18—should not, under any circumstances, be given the following OTC medications:
Please indicate:*
- I consent
- I do not consent
CONSENT AGREEMENT
AUTHORIZATION AND RELEASE This Consent Agreement, Authorization and Release must be read and signed to be eligible to attend Next Step's Young Adult Campference. RELEASE OF LIABILITY I understand that occasionally accidents occur during campference activities and that participants may sustain serious personal injury and property damages as a consequence thereof. Knowing the risks of campference activities, nevertheless, and in consideration of my acceptance for participation at a campference, I hereby agree to assume those risks and to hold harmless Next Step, and all campference agents, representatives, employees and volunteers, from any and all liability, claims for personal injury and/or property damage, costs, expenses and damages arising out of or connected in any way with my participation in campference activities. Further, I acknowledge that Next Step accepts no responsibility for the loss, damage or theft of my personal property.
Please indicate:*
- I consent
- I do not consent
CONSENT FOR MEDICAL TREATMENT
The undersigned hereby grants permission to the medical staff or consulting physicians at Next Step to administer medication and provide medical care for me, including any medical emergency care required. I also give my consent for any emergency transportation deemed necessary.
Please indicate:*
- I consent
- I do not consent
Community Agreement/Rules of Conduct
The young adult campference is a close-knit community; therefore we ask that you agree to a few things that will promote being together in a safe manner. Please sign this Community Agreement, which asks that you agree to conduct yourself ethically and respectfully while living in the program:*
- 1. Delegates are to demonstrate a high degree of maturity and self-respect, taking into account the rights and feelings of others.
- 2. Delegates are responsible for charges incurred, e.g. vandalism and breakage of property, etc.
- 3. Delegates are to adhere to curfews, directives and designated schedule times.
- 4. Suitable attire is to be worn during the campference workshops and activities.
- 5. Smoking is prohibited indoors.
Please select as an indication that you will adhere to the code of conduct.
The Following Behaviors are grounds for Immediate Dismissal:*
- 1. Physical confrontations or assaults. This means harming, attempting to harm, or threatening to harm another person, with or without a weapon or dangerous object
- 2. Bullying. As defined as unwanted, aggressive behavior that involves a real or perceived power imbalance. The behavior is repeated, or has the potential to be repeated, over time. Verbal bullying is saying or writing mean things. Social bullying involves hurting someone’s reputation or relationships and can include leaving someone out on purpose, telling other’s not to be friends with an individual, spreading rumors, embarrassing someone.
- 3. Stealing or damaging property
- 4. Possession or use of drugs and alcohol
- 5. Sexual misconduct or sexual assault
- 6. Leaving without permission
- 7. The possession of any type of weapon
Please select as an indication that you understand the behaviors that are unacceptable at the program.
Please indicate:*
- I agree to the community agreement
- I do not agree to the community agreement
PHOTO AND INFORMATION RELEASE
I give Next Step permission to photograph and use pictures or visual and/or audiotapes of me in professional or fundraising activities. On occasion, with this permission, participant photographs may be included on the Next Step website, on a bulletin board, video, newsletter, campference album, or in personal photographs. Next Step respects the privacy of participants and does not allow unauthorized visitors to photograph the campference or participants. In addition, by signing below, I give Next Step permission to give my name, address and/or phone number to groups or individuals wishing to support Next Step by inviting me to an event or by sending me information related to Next Step. This list will not be sold or given to anyone else for any other reason.
Please check appropriate box and provide your signature below:*
- I agree to the photo release
- I do not agree to the photo release
Please Sign
By signing below, I hereby acknowledge that I have read and fully understand the terms and expectations of the program. All information provided is current and accurate to the best of my knowledge.
Name*
First Last
Date*
MM slash DD slash YYYY
Please check this box to indicate that the above signature will serve as your electronic signature
- (Delegate or Legal Guardian if the Delegate is not over the age of 18)

Experience
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COMMUNITY
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MENTORSHIP

Next Step Summer Campferences are coming soon!

; Next Step @nextstepfund ·

9 Apr 1777745371940151623

A special shout out and thank you to the talented photographer Kyle Klein and the amazing young people who recently helped us out with a fun marketing project at the Next Step office. We are so grateful for all of you and your support of our community. You’re changing lives.

Twitter feed image.

Reply on Twitter 1777745371940151623 Retweet on Twitter 1777745371940151623 0 Like on Twitter 1777745371940151623 0 Twitter 1777745371940151623

nextstepfund

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Apr 16

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What a beautiful day in Boston yesterday for the @bostonmarathon!

All of us at Next Step want to send a huge thank you to our 2024 Boston Marathon team - Chase Carpenter, Tommy Bannan, Sean Foley, Valerie Degrez, and Josepth Mueller.

All five runners conquered the 26.2 miles on a really warm day. Not only did they cross the finish line with smiles, they raised a Team Next Step record $66,746(!) to help fund our community, music and mentorship programs for seriously ill young people.

We are so grateful to partner with these five amazing people who volunteered their time to train for one of the toughest marathons while raising critical funds that will help us welcome more young people into the Next Step community at no cost to them or their family.

A special thank you to the @bankofamerica charity marathon program for inviting us to participate in this year`s marathon.

Thank you and congratulations, Team Next Step!

#BostonMarathon #BostonMarathon2024 #IBelieveInMe #Teens #YoungAdults #Cancer #HIV #RareGeneticDisorders #ChronicIllness #Community #MusicTherapy #Mentorship #Boston #BostonMA ...

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nextstepfund

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Apr 9

Open

A special shout out and thank you to @kylekleinphoto and the amazing young people who recently helped us out with a fun marketing project at the Next Step office. We are so grateful for all of you and your support of our community. You’re changing lives.

Visit Kyle’s website if you’re looking for a talented photographer in the Boston area: www.kylekleinphotography.com

#ThankYou #Photographer #Photography #Boston ...

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Join our 2022 Spring Campference for Young People Living with HIV

Apply to our Spring 2022 Weekend Campference

PARENT/GUARDIAN OR EMERGENCY CONTACT

Medical Overview

INSURANCE INFORMATION

CONSENT AGREEMENT

CONSENT FOR MEDICAL TREATMENT

Community Agreement/Rules of Conduct

PHOTO AND INFORMATION RELEASE

Please Sign

Experience
Next Step

Next Step Summer Campferences are coming soon!

Upcoming Events

20 May

Next Step Mentoring Program Summer 2024

Stay in touch! Sign up for news and updates.

Join our 2022 Spring Campference for Young People Living with HIV

Apply to our Spring 2022 Weekend Campference

PARENT/GUARDIAN OR EMERGENCY CONTACT

Medical Overview

INSURANCE INFORMATION

CONSENT AGREEMENT

CONSENT FOR MEDICAL TREATMENT

Community Agreement/Rules of Conduct

PHOTO AND INFORMATION RELEASE

Please Sign

ExperienceNext Step

Next Step Summer Campferences are coming soon!

Upcoming Events

20 May

Next Step Mentoring Program Summer 2024

Stay in touch! Sign up for news and updates.

Experience
Next Step