Camp John Marc · Volunteer Application

Criteria for Volunteering:

be at least 18 years old (with transportation to/from camp)
be able to safely lift 50 lbs. (with/without reasonable accommodation)
submit and clear a criminal background check
comply with current COVID-19 policies including fully vaccinated as defined by the CDC, masking when within six (6) feet of campers (indoors and outdoors), and submitting a negative COVID test prior to arriving at Camp.
submit proof of COVID-19 and flu vaccines

Contact Information

Name

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First Name

Last Name

Current E-mail Address

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Verify Email

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Primary Phone Number

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Date of Birth

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(mm/dd/yyyy)

Gender

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Male

Female

Non-Binary/Other

Preferred Pronouns:

Maiden or Other Former Legal Names (mark N/A if this does not apply)

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Marital Status (mark N/A if this does not apply)

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Spouse's Name (mark N/A if this does not apply)

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First Name

Last Name

Current Address

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Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Length of Time Resided

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Residential History (mark N/A if this does not apply)

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Please list the areas you have lived since the age of 16. City, State, length of residence (e.g. Dallas, Tx, June 2011-August 2012)

Education

High School Attended

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School, Dates Attended, Degree

College/University Attended

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School, Dates Attended, Degree

Emergency Contact

Emergency Contact Name

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First Name

Last Name

Emergency Contact Phone Number

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Emergency Contact Relationship to You

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Short Answer Questions

How did you learn about Camp John Marc?

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Please describe your previous volunteer or work experience with children and teenagers. Please include any previous experiences working with individuals with medical or physical challenges.

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Please describe your previous camp experience (personal or as a counselor).

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Please describe your expectations as a Camp John Marc volunteer.

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Have you ever been fired or terminated for cause from any job, or have you ever been suspended or required to withdraw from a school? If yes, please explain.

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Have you ever been accused of, charged with, or convicted for any crime, including child molestation or any crime endangering a child? If yes, please explain.

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Have you ever been charged with DWI or DUI or other motor vehicle offense? If yes, please explain and list year, charge, county, and state.

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Has your driver's license ever been revoked or suspended? If yes, please explain.

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References

Please list the details of three (3) persons who have knowledge of your character, experience, and abilities. One reference must be a person of the opposite gender, one a family member, and one non-family members. Please note, current contact information is required for all references.

Reference #1 OPPOSITE GENDER

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First Name

Last Name

Reference #1 Email

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Verify Email

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Reference #1 Relationship (Personal or Professional)

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Reference #2 FAMILY MEMBER

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First Name

Last Name

Reference #2 Email

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Verify Email

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Reference #2 Relationship

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Reference #3 NON-FAMILY MEMBER

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First Name

Last Name

Reference #3 Email

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Verify Email

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Reference #3 Relationship (Personal or Professional)

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Activity Areas

Please complete this section if you are applying to be a weekend camp volunteer. Side/Lead Walker Volunteers do not need to complete this section.

Weekend Camp Activities

Please check the activity areas that you have experience with and would feel comfortable leading. Those areas which require a certification are marked with an asterisk.

Fishing

Cooking

Nature

Sports & Games

Weird Science

Archery (requires certification)

Ropes Course (requires certification)

Please describe your experience with the activities you have marked above.

Please list any current certifications you have; including challenge course, archery, lifeguarding, etc.

Medical Information

For your health and safety, please check any medical conditions you currently have.

Allergies

Asthma

Diabetes

Eczema

Hay Fever

Heart Disease/Defect

Other

Please list all medications you currently take.

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Please list any allergies you have.

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Please list any restrictions or limitations you have.

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Do you feel you can safely lift 50 pounds (with/without reasonable accommodation)?

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Yes

No

Do you currently use any illegal drugs?

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Yes

No

Proof of Flu Vaccination

Date of Flu Vaccine

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(mm/dd/yyyy)

COVID-19 Vaccination Card (Front):

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COVID-19 Vaccination Card (Back):

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Physician's Name

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First Name

Last Name

Physician's Phone

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Camp John Marc Release and Indemnity Agreement

Please read this Release and Indemnity Agreement (“Release”) carefully before signing. All references to “Participant” shall be deemed to include staff and volunteers.

A. PARTICIPATION CONSENT Participant understands and acknowledges that risks and dangers exist during the camp program(s) that Participant has applied to attend and that occasionally accidents occur during camp or retreat activities and that Participant may sustain serious personal injury and property damages as a consequence of such activities. These activities include but are not limited to the potential hazards of boating, swimming, horseback riding, archery, sports, ropes or challenge course exercises, climbing structures, hiking, camping, cooking, and potential hazards of the presence of wildlife, depending on other people, accident or illness, the forces of nature, extreme temperature, inclement weather and travel by air, train, boat, automobile or other conveyance. Participant understands that while the user group will have medical staff on-site, the closest emergency room is approximately twenty (20) miles from CJM, and emergency services for the area where CJM is located are volunteer Bosque County EMS. Knowing the risks of camp and retreat activities, nevertheless, Participant agrees to assume those risks. Participant is not under and will not be under the influence of any chemical substance (except prescription medicine taken as prescribed), including alcohol, while at CJM or traveling to or from CJM. Participant understands that participation in this program is entirely voluntary and that Participant may elect to participate, decline to participate, or limit or discontinue participation at any time. Participant has applied for this program and accepts full responsibility for Participant’s decision to participate or not to participate and agrees to follow all safety instructions. Participant understands and agrees that Participant will be in an environment that involves elements related to nature, camping or community living such as insects and insect bites, sun exposure, or communicable illness, including Covid-19.

B. MEDIA RELEASE Participant understands that this media release is granted for the use and benefit of CJM. Participant gives permission and consent for CJM to interview and/or take photographs, audio or audio-visual recordings of Participant and grants CJM permission to use Participant’s likeness or voice in television, film, video, print or other media used to promote or publicize CJM, or the camp session Participant attends; provided these materials are distributed without a specific charge to the recipient except for the cost of precuring any mass media materials in which they are incorporated. I acknowledge that CJM shall have all rights of copyright in and to such photographs, videos, audio and images and may use such copyright fully. I also hereby release Camp John Marc, and Camp John Marc Foundation, Inc. and the user group(s) and their employees, agents and directors, for liability connected with the taking of and use of these materials. In addition, I waive all rights, interest or claims for payment in connection with any exhibition or release of these materials. This consent is voluntary, and I give it in the interest of public information, education, the furtherance of the goals of CJM, or other lawful purposes.

C. RELEASE AND INDEMNITY For and in consideration of the right to participate in a camp program and the services and food arranged for me, by Camp John Marc, the user group(s) sponsoring the camp session I attend, the undersigned, on behalf of myself completely release, acquit, and forever discharge Camp John Marc, Camp John Marc Foundation, Inc. the user group(s) sponsoring the camp session Participant attends, and their respective counselors, employees, volunteers, directors, officers, agents, affiliates, partners, members, shareholders and/or associates (hereinafter collectively referred to as the “Released Parties”) of and from any and all claims, demands, causes of action, obligations, liens, damages, losses, costs, attorneys’ fees and expense of every kind and nature whatsoever, whether for bodily injury, property damage or loss or otherwise, which the undersigned now has or which may arise from or in connection with participation in any activities arranged for me by CJM, the user group(s) sponsoring the camp session, and/or the Released Parties. It is the express intention of the undersigned that this Release is a full release of the Released Parties for the consequences of the Released Parties’ own actual or alleged negligence, gross negligence, strict or absolute liability, or other fault. I agree to be liable for attorneys’ fees and court costs of the Released Parties and myself associated with claims and/or litigation brought by or on behalf of Participant and/or me against CJM, the user group(s) or the Released Parties.

INDEMNITY: It is further expressly agreed and understood that the undersigned will defend, indemnify and hold harmless the Released Parties from any liability, judgment or claim asserted by, through or on behalf of the undersigned who are participating in camp activities, arising out or in any way pertaining to the participation in a camp program and the services and food arranged for the undersigned. The foregoing obligations to defend, indemnify and hold harmless shall be enforceable without regard to the actual or alleged negligence, gross negligence, strict or absolutely liability or other fault of the Released Parties, it being the express intention of the undersigned to indemnify the Released Parties for the consequences of the Released Parties’ own actual or alleged negligence, gross negligence, strict or absolute liability or other fault.

Additionally, Participant understand that the information on this application is submitted for the use and benefit of both Camp John Marc and the user group sponsoring any specific camp session. Participant consents to either or both Camp John Marc or the user group reviewing this information, checking references (listed or unlisted), and/or conducting a criminal and other background check. Participant understands that if their application is not accepted, they may not be given a reason for that decision and that if selected, such a position will be unpaid and "at will," and can be terminated at any time by Camp John Marc or the user group.

Release Statment

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By checking this box, I agree that I have read through the Camp John Marc Release and agree to the terms listed above.

Electronic Signature

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Background Check Verification & Release

Background Check Release Statement

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By checking this box, I agree to submit a background check when it is requested of me.

Authorization and Acknowledgement

The facts set forth in this application and any supplemental information are true and complete to the best of my knowledge. I understand that, if my application for volunteering is accepted, falsified statements on this application shall be considered sufficient cause for immediate discharge. I hereby authorize investigation of all statements contained herein and employers listed above to give you any and all information concerning my employment, and any pertinent information they may have, and release all parties from all liability for any damage that may result from furnishing same.
I understand that neither the completion of this application nor any other part of my consideration for volunteering establishes any obligation for the company to accept my application. If I am approved for volunteering, I understand that either the company or I can terminate my volunteer role at any time and for any reason, with or without cause and without prior notice. I understand that no representative of the company has the authority to make any assurance to the contrary.

I understand that I am required to abide by all rules and regulations of the company.

Authorization and Acknowledgement

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By checking this box, I agree that I have read through the authorization and acknowledgement and agree to the terms listed above.

Electronic Signature

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Date

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(mm/dd/yyyy)