One moment please...
Volunteer Counselor Application
Name
*
First Name
Last Name
Cell Phone
*
Email
*
Verify Email
*
Address
*
Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
Country
Birthdate
*
(mm/dd/yyyy)
Gender
*
Female
Male
Other
Emergency Contact Name
*
First Name
Last Name
Relationship to you
*
Emergency Contact Phone Number
*
How did you hear about Camp Sparkle
*
From a teacher/school counselor
From a parent
From a friend
Presenter at my school
Flyer
Cancer Pathways Website
Online search
Other
What camp locations are you interested in?
*
Seattle: July 6-10
Tacoma: July 13-17
Tacoma: July 20-24
Bellevue: August 3-7
Everett: August 10-14
Are you currently certified in any of the following?
CPR/AED
First Aid
Lifeguard
Other
Education Level
High school student
Undergraduate student
Masters student
Not currently in school
Do you have experience working with children in a summer camp environment or elsewhere?
*
Yes
No
Pleas describe your experience working with children.
*
Do you have previous volunteer experience?
*
Yes
No
Please describe your previous volunteer experience.
*
Do you have your own cancer experience?
*
Yes
No
Please describe your experience with cancer.
*
Why do you want to volunteer at Camp Sparkle?
*
Eligibility
Have you ever been convicted of a crime or have any charges pending against you for any crime?
*
Yes
No
Has a court or state agency ever issued you an order or other final notification stating that you have sexually abused, physically abused, neglected, abandoned, or exploited a child, juvenile, or vulnerable adult?
*
Yes
No
Cancer Pathways conducts background checks on all volunteer applicants. By checking this box you agree to a WA State Patrol background check.
*
Yes
No
References
#1 Reference Name
*
First Name
Last Name
#1 Reference, relationship to you
*
#1 Reference email
*
Verify Email
*
#2 Reference Name
*
First Name
Last Name
#2 Reference, relationship to you
*
#2 Reference email
*
Verify Email
*
Volunteer Service Agreement
*
1. Policy and procedures adherence: The volunteer takes responsibility for knowing and adhering to the policies of Camp Sparkle and the Volunteer Counselor Handbook. 2. Termination: The Family Program Manager has the right to terminate this service agreement at any time if they believe the performance of the volunteer is detrimental to the interests of Camp Sparkle. 3. Consent for medical treatment: I hereby give permission to be given cardiopulmonary resuscitation (CPR) and first aid treatment by a qualified staff member of Cancer Pathways, if needed. I further consent to the disclosure of health information and to the medical, surgical and hospital care treatment and procedures to be performed by licensed physician or hospital selected by Camp Sparkle staff when deemed immediately necessary or advisable by the physician to safeguard my health. I assume full financial responsibility for any and all medical and other expenses incurred on my behalf at Camp Sparkle in connection with medical treatment or other treatment, and acknowledge that Camp Sparkle shall not be liable for any such expense. 4. Confidentiality: The volunteer will not release or discuss information gained from any source, written or verbal, about camper’s records and personal information except as required in the work assignment. Use of camper photographs on personal websites or social media is strictly prohibited. 5. Communication: The volunteer should not initiate communication or contact with campers outside of Camp Sparkle without parental consent. Parental consent should be obtained through the Family Program Manager or Camp Director. 6. Photo release: I hereby give Cancer Pathways and its employees, representatives, and authorized media organizations permission to print, photograph, and record me during Camp Sparkle for use in audio, video, film, or any other electronic, digital and printed media in order to promote or market Camp Sparkle. This is with the understanding that neither Cancer Pathways nor its representatives will reproduce said photograph, interview, or likeness for any commercial value or receive monetary gain for use of any reproduction/broadcast of said photograph or likeness. I further release and relieve Cancer Pathways, its Board of Trustees, employees, and other representatives from any liabilities, known or unknown, arising out of the use of this material. The camp respects the privacy of its participants and does not allow unauthorized visitors to photograph the camp.
I have read and understand the above and completed this form to the best of my ability
Electronic Signature
*
Date
*
(mm/dd/yyyy)