Camp Hamwi

Demographic Information
In what state does your camper reside?*
In what county does the participant primarily reside?*
What is the participant's ZIP code?*
With which gender identity does the participant identify?*
What is the ethnicity of the participant*
What is the approximate income of the participant's family?*
What is your role in relation to the diabetes community?*
- Patient
- Caregiver
- Unaffected volunteer
- Other
Who is the primary caregiver for the participant*
What is the age of the participant (including staff)?*
Does your participant consistently see an endocrinologist?*
- Yes
- No
Does your participant have a primary care physician?*
- Yes
- No

Post-Camp Survey Questions
The following information is used to help us plan educational opportunities. These questions were asked to you before camp and are being asked once more in an effort to measure the impact of our program. Please answer honestly using a scale of 1-5 to rate your child's CURRENT status. 1 = Poor 2 3 = Average 4 5 = Excellent
Monitoring blood glucose*
Please enter a number from 1 to 5.
Properly disposes testing and insulin supplies*
Please enter a number from 1 to 5.
Selecting and rotating injection/pump sites*
Please enter a number from 1 to 5.
Recognizing signs and symptoms of low blood glucose*
Please enter a number from 1 to 5.
Treating low blood glucose*
Please enter a number from 1 to 5.
Recognizing symptoms of high blood glucose*
Please enter a number from 1 to 5.
Monitoring ketones*
Please enter a number from 1 to 5.
Understanding A1C*
Please enter a number from 1 to 5.
Decreasing risks for developing chronic complications*
Please enter a number from 1 to 5.
Foot care*
Please enter a number from 1 to 5.
Adjusting insulin doses*
Please enter a number from 1 to 5.
Counting carbohydrates*
Please enter a number from 1 to 5.
Incorporating physical activity*
Please enter a number from 1 to 5.
Overall adherence to self-care plan*
Please enter a number from 1 to 5.
Attitude towards diabetes*
Please enter a number from 1 to 5.
Level of confidence/self-esteem*
Please enter a number from 1 to 5.
Does your participant pump?*
- Yes
- No
Willingness to discuss their diabetes*
Please enter a number from 1 to 5.
Preparing pump supplies*
Please enter a number from 1 to 5.
Changing pump site*
Please enter a number from 1 to 5.
Basic pump programming*
Please enter a number from 1 to 5.
Setting temporary basal rates*
Please enter a number from 1 to 5.
Suspending pump*
Please enter a number from 1 to 5.

Post-Camp Survey Questions
Does your participant inject?*
- Yes
- No
Has your participant ever attended camp?*
- Yes
- No
How many times has your participant attended a CODA camp in the past?*
Please enter a number from 0 to 20.
What did you hope your participant would learn by attending camp?
What did your participant hope to learn by attending camp?
Reflecting back on the 2 weeks of camp, were your hopes and those of the participant met? Elaborate if possible.
What is your participant's attitude toward diabetes?
How well does your participant relate to other children their own age?
Hidden
How does your participant feel about attending camp? Does your child have any specific apprehensions about camp?
Hidden
Does your participant have any other health or behavior issues or special needs that may affect their care at camp?
Hidden
The Central Ohio Diabetes Association offers programs for youths throughout the year. What types of additional youth programs would you like to see offered? Please state best day, time and location (i.e. name of village, town or city).
Hidden
The Central Ohio Diabetes Association offers programs for families throughout the year. What types of additional family programs would you like to see offered? Please state best day, time and location (i.e. name of village, town or city).
Any other comments or suggestions?

Camp Questions
Please answer the following questions about these camp activities: Campfire night, bird feeder craft, dietary learning with Brandon, medical learning with Becky & Krista, PANIC!, Bingo, drawful/Pictionary, Dutch auction, jigsaw puzzles, Smunchies, charades, craft night (bracelets, flowerpots, balloon tennis racket), Scavenger Hunt & Rock/Paper/ Scissors, Jackbox night, CIT Activity night, “Stump the Docs,” Choose your own adventure, canvas bags, escape room, talent show, closing campfire.
Overall when it comes to camp sessions my participant thought they were:
Which session was your participant's favorite and why?
Which session was your participant's least favorite and why?
What additional feedback do you or your participant have regarding camp activities?
Has your participant told you anything about the camp experience that they did not enjoy?
What can we do to make the camp experience better for you, as a caregiver?

Virtual Camp Survey

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Demographic Information

Post-Camp Survey Questions

Post-Camp Survey Questions

Camp Questions

Camp Questions

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