Volunteer Application

I authorize emergency treatment for myself if I am injured or taken ill during my service at camp if I am not able to give consent for treatment and the staff is unable to reach my emergency contact named above. I give full permission for use of my name, photograph, or voice in promoting VACC Camp without limitation, reservation, or compensation.

First name:
Last Name:
Home Phone:	( ) - Second three digits Last four digits
Cell Phone:	( ) - Second three digits Last four digits
Address:
City:
State:
ZIP code:
Email:
T-Shirt Size:
Birthday:	Today

Are you currently employed?:



Are you presently a student?:




Are you currently certified in any of the following?:
First Aid CPR Life Guard

List and describe any previous volunteer and/or camp experience you may have:


List any skills, intrests, or hobbies or experiences you have had with children:

Reference #1 First Name:	Name someone from the community or work. Do not use a relative
Reference #1 Last Name:
Reference #1 Relation:
Reference # 1 Phone:	( ) - Second three digits Last four digits
Reference #2 First Name:	Name someone from the community or work. Do not use a relative
Reference #2 Last Name:
Reference #2 Relation:
Reference #2 Phone:	( ) - Second three digits Last four digits

Emergency Contact First Name:
Emergency Contact Last Name:
Emergency Contact Relation:
Emergency Contact Home Phone:	( ) - Second three digits Last four digits
Emergency Contact Work Phone:	( ) - Second three digits Last four digits
Physician First Name:
Physician Last Name:
Physician Phone:	( ) - Second three digits Last four digits

Commitment:
I understand the following statement. I understand that my service is important to the camp's success. I promise to serve the hours assigned and if I cannot be at the camp, I will promptly inform the camp coordinator.

Consent:
I acknowledge the above information is true and correct I authorize emergency treatment for myself if I am injured or taken ill during my service at camp if I am not able to give consent for treatment and the staff is unable to reach my emergency contact named above. I give full permission for use of my name, photograph, or voice in promoting VACC Camp without limitation, reservation, or compensation.

Volunteer Signature (Full Name):
Date:	Today
Are you under the age of 18?:

Volunteer Information

Education and Experience

References

Emergency Contact

Consent

Health Form

Shake-A-Leg

Hour Pledge Form

Letters of Recommendation

Photo Upload

Have you had any of the following?:
Chicken Pox Rubella Measles None of the above

Have you been immunized for any of the following?:
Chicken Pox Rubella Measles None of the Above

Have you ever had a a Turboculosis test?:


Do you have/ or are being treated for any of the following:
Allergies Asthma Chronic cough Diabetic on Insulin Epilepsy Hearing Problems Immune Deficiency Skin Disorders/Rashes Partial Blindness Wrist, Back or Neck Injury None of the above

List all medications you are taking:


Describe any physical limitation(s) you have that staff should be aware to help you participate fully as a camp volunteer:

Shake-A-Leg Consent Form:
Upload the Shake-A-Leg Participant Consent form provided online

I plan to help out at VACC Camp as a:
Full Time Volunteer Part Time Volunteer

Signature (full name):
Date:	Today

Are you a new volunteer?:

Photo:
Please provide a recent photo.