Camp Good Days and Special Times Summer Program Volunteer Application Must be 18 years of age to apply Today’s Date:_________________ Required fields are denoted by * I will be 17 years of age at the beginning of my program.* Yes _____ No _______ Applicants Full Name: * ________________________________________________ Street Address: * _____________________________________________________________________ City: *_______________________________ State: * __________ Postal Code: *________________ Country: * _____________ Phone Number: * ___________________ Email Address: * ___________________________________________ I am 18 years of age or older: * Yes ____ No____ Date Of Birth: _______________ ______ Please check here if you will be under the age of 18 at the time of your selected program. You will be automatically selected as a Counselor In Training, and must attend the MANDATORY overnight training Saturday, June 20, 2015 – Sunday, June 21, 2015 to be considered. School or Business Address (If Applicable) Street Address: _______________________________________________________________ City: _______________________________ State:__________ Postal Code: ___________________ Country: _____________ Phone Number: ___________________ Email Address: ___________________________________________ Employment (if Applicable) Employer: __________________________________________________________________________ Position: _________________________________________________ Do you carry Medical / Health Insurance? *Yes____ No____ If “Yes,” Carrier* ___________________________________ Group Policy # * ___________________________________ ID# *_______________________________ Gender: Male ______ Female ______ Choosing A Program It is important to understand that we look for people with different experiences. You MUST identify more than one program that you would be willing to volunteer for. Number the programs by preference. Please understand that we may ask you to volunteer at a camp session that is not your first choice. If you choose one program, your application will not be processed. NOTE Volunteers applying for the Junior Good Days Programs may select only 1 program. Information on the various programs can be found in the programs section of the web site. Some of the program descriptions may have changed since last summer. Please number your top three choices for programs, with “1” being the highest. If you are selected, more detailed information about each specific program will be forwarded to you. Camp Childhood USA I Doing A World Of Good Camp Childhood USA II Teddi’s Team Junior Good Days Rochester Camp B&ST Junior Good Days Syracuse Junior Good Days Buffalo ** I would be interested in volunteering for year-round monthly programs in the following region(s): Rochester _____ Buffalo ______ Syracuse ______ Ithaca ______ Volunteer Position: Your volunteer responsibilities will be based upon the specific program’s needs. The majority of volunteers are selected to serve as counselors with the campers in cabins. However, if there is a specific area in which you would like to volunteer, please indicate that below. __________________________________________________________________ Have you attended any of our programs before? If yes, please indicate program(s) and year(s). Where did you learn about Camp Good Days? Do you know anyone involved in any of our programs? Name(s) Certifications Any certifications you may have that will pertain to your volunteer activity must be current through September 2015 or later. Copies of all certification cards / licenses MUST be forwarded. FAX 585-624-5799 Attention Volunteer Coordinator. Mandatory:* New York State Health Department requires ALL applicants to enclose a biography. We need to know about you, your experiences with Camp Good Days and Special Times, our programs, or anything that relates to your dealing with children who have special needs. Please include information on current certifications, areas of expertise, or any physical disabilities, which you may have, and how we may accommodate you. References* Give the names and addresses of 3 people (not relatives) having knowledge of your character, experience and ability. References are required even for returning summer staff. Failure to do so will result in an unprocessed application Name: ____________________________________________________ Address: ______________________________________________________________________ Phone: _________________________ Name: ____________________________________________________ Address: ______________________________________________________________________ Phone: _________________________ Name: ____________________________________________________ Address: ______________________________________________________________________ Phone: _________________________ Training New York Law requires that all applicants attend a training session prior to their camp session. Attendance is MANDATORY. If you do not attend the training session, you will not be able to volunteer at camp. Please Read Carefully: I am aware that in being accepted as a volunteer, I am committed to complete the MANDATORY TRAINING requirement by attending the below checked training program. The information provided by me in the volunteer application is true and complete to the best of my knowledge. I understand that if I am selected, any false statements will be considered cause for possible dismissal. You are hereby authorized to conduct a criminal background investigation of myself. By volunteering for a camp session, you are making a commitment for the entire session for which you are selected. Early departure from a program is unfair to the campers and other volunteers; therefore it is not encouraged. Volunteers are expected to remain on the Camp Property at all times during the camp session. ______I am a NEW volunteer and I will be attending the MANDATORY training at the Branchport, NY Recreational Facility on Saturday, June 20, 2015 ______I am a RETURNING volunteer and I understand I must attend a training session on the day of or evening prior to the start of my program I have been charged or convicted of any crime involving children under 18 years of age* Yes _______ No_______ If you have, please explain All Camp Good Days medical forms will be completed online. Once accepted into a program Camp Good Days will send you a link to its online medical forms, to the email address provided. Please enter or sign your full legal name, verifying that you have read, understand, and agree to the statements written above. * X___________________________________________________ Date:_________________________ All of the information provided in this form is considered confidential and is not shared with any person or agency outside of Camp Good Days and Special Times, Inc. Please Return Completed Forms To: Jennifer Graham Volunteer Coordinator Camp Good Days and Special Times PO Box 665 1332 Pittsford-Mendon Rd. Mendon, NY 14506 Email - jgraham@campgooddays.org Fax - 585-624-5799 Phone - 585-624-5555
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