Volunteer Form

* Required

Personal Information

Title

First Name *

Last Name *

Middle Initial *

Email Address *

Date of Birth *

Gender *
Male
Female

T Shirt Size *

Home Address *

City *

State *

Zipcode/Postcode *

Country *

Home Phone Number

Cell Phone Number *

Volunteer Availability

Have you volunteered with us before?
Yes
No

If so, when?

How did you hear about Camp? Are you affiliated with a partnering group or hospital? *

Day and Ongoing Volunteers: Please check which positions you are interested in:
Barn
Woodshop Cutters
Housekeeping
Maintenance
Lifeguard
Dining Hall

Please list days and times available: *

Family Weekend Volunteers (3 days):
Den Counselor
Program Counselor

Summer Camp Volunteers (1 week):
Den Counselor

Inquiry Questions

Why do you want to work with children who have life-threatening illnesses? *

What experience do you hope to get out of camp? *

Education

High School

High School (Include City/State): *

Dates Attended: *

Did you graduate? *
Yes
No

College

College (Include City/State):

Diploma/Degree/Certification:

Dates Attended:

Graduate School/Other

Dates Attended:

Diploma/Degree/Certification:

Please mark any certifications (We reserve the right to request copies of any marked certifications): *
First Aid
CPR
Lifeguard
Other
None

Please list any languages you speak fluently (other than English):

Previous Employment

Employer *

Work Address *

City *

State *

Zipcode/Postcode *

Country *

Supervisor: *

Employer's Phone Number: *

Employer's Email: *

Employment Start Date: *

Employment End Date:

Your Job Title: *

Previous Camp Experience

Camp Name

Camp Address (Include City, State, and Zip):

Supervisor

Employer's Phone Number:

Employer's Email:

Employment Start Date:

Employment End Date:

Your Job Title:

References

Reference #1 (non-family member): *

Reference #1 Relationship *

Reference #1 Occupation *

Reference #1 Email Address: *

Reference #2 (non-family member): *

Reference #2 Relationship: *

Reference #2 Occupation: *

Reference #2 Email Address: *

Background Information

Has your name ever appeared on a sex offender registry? *
Yes
No

Have you ever been convicted of any crime except a minor traffic offense? *
Yes
No

Has your driver's license ever been revoked or suspended? *
Yes
No

Have you ever been fired for cause or suspended/expelled from school? *
Yes
No

If you answered yes to any of the above questions, please explain. Please answer honestly. We run a nation-wide criminal background check on all applicants.

Certification/Agreement

The facts set forth in my application are true and complete. I understand that if accepted, false statements on my application shall be considered sufficient cause for dismissal. I authorize the use of any information on this application and attached supplements to verify my statements, and I authorize Camp to contact the past employers, schools, and all references listed above.

I agree to the terms set forth in the above agreement. I understand that by selecting YES below, I give my consent to the above agreement (equivalent to my written signature). *
YES

Date *

If applicant is under 18: As the parent/guardian of applicant, I agree to the terms set forth in the above agreement. I understand that by selecting YES below, I give my consent to the above agreement (equivalent to my written signature).
YES

Date