Camp Volunteer Registration

Name

First Last

Age

Phone

Email

Address

Street Address City State ZIP Code

Group Affiliation

Special Diet/Allergies/Other Considerations?

Health Insurance Information

Have you had chickenpox or been vaccinated against chickenpox?

I give permission for my photos to be used in Camp PR and/or fundraising efforts.

When will you arrive at camp?

When will you depart from camp?

Would you be willing and able to provide transportation for other volunteers to/from camp?

Personal/Professional Reference

First Last

Reference Phone Number

Emergency Contact

First Last

Relation

Emergency Contact Phone

Do you prefer to work with children under 10 years old or over 10 years old?

Which of these skills would you be willing to provide?

Do you have experience supervising/caring for children 18 and under?

Anything else you think we should know about you?