Celiac Strong Camp Inc
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Celiac Strong Camp Registration Request Form for Volunteers
We are pleased to be hosting Celiac Strong Camp for our 7th year and that you have selected to volunteer with us. You must be at least 18 years old to volunteer and be 21 to be a camp counselor. We will make selections based on our camp registration needs. There will be a background check and a phone interview. You will be required to complete an application, training and camp forms prior to the due date.
There will be a training session
prior to the start of camp
.
Thank you for your interest in volunteering & assisting in making this camp a success.
We are looking forward to sharing smiles & having a wonderful camp experience together.
Please note.
Volunteers will practice safety to keep themselves and our campers safe, sleep in rustic cabins, create an atmosphere to keep our campers' behaviors in check with each other and be respectful to each other as well as to the activity counselors. I selected, you must keep a positive attitude towards campers and all volunteers.
To assist in all program activities. Volunteers will make sure that they help in all areas of camp which will include maintaining the safety of our campers, making sure they stay in their cabins at designated hours and know their whereabouts at all times, send campers out with a buddy and know what time they are expected back (reasonable) from the restroom or nurse's office, assist with dishes after meals, assist with all programs including with the fishing program which includes removing fish off of hooks & assisting with baiting hooks and counting campers during swim time and other programs.
This is a camp, no air conditioning and you will be sleeping in a rustic setting.
We all work hard but seeing the children having fun is worth it all. Thank you for your registration request.
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Indicates required field
Name
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First
Last
Your Gender
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Male
Female
Age on 8/9/2017
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18-20
21 and over
Date of Birth (Month/Day/Year)
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WE require this information as a part of your background check as safety precautions for our campers.
Email to be used for primary communication
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Address
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Line 1
Line 2
City
State
Zip Code
Country
Primary Phone Number EXAMPLE (585) 230-0363
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Please enter camper's primary phone number for first point of any contact. Please enter numbers only with area code first, no other characters.
Cell Number
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example: (585) 230-0363
T-shirt Size (in August)
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Adult Small
Adult Medium
Adult Large
Adult XL
Adult 2XL
Adult 3XL
Adult 4XL
This will be my ______ year at camp
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1st
2nd
3rd
4th
5th
6th
7th
Is a lactose free diet required for Camper? Please note that we will not be able to accommodate any other diet other than gluten free & lactose free.
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Yes, Lactose Free Diet required
No
Please check yes if lactose free diet is necessary.
Celiac Strong Camp will not be able to accomodate any other dietary intolerance, allergies and / or sensitivities (other than gluten and lactose free). Please know we will not assume responsibility for any other dietary constraints. We regret the inconvenience that this poses to attendees and appreciate your understanding of our policy. By checking this box, you agree and unsertand this policy.
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I understand and agree that Celiac Strong Camp can only accomodate lactose and gluten free diets.
I agree: ​Release of (Hold Harmless Agreement) Liability and Assumption of Risk Agreement: 1. The risk of injury from the activities involved in this program, Celiac Strong Camp, Inc., is sufficient, including the potential for permanent paralysis and death, and while particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist;and. 2. I, KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my participation; and. 3.1, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE, INDEMNIFY, AND HOLD HARMLESS Celiac Strong Camp Inc., its officers, officials, agents and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and, if applicable, owners and lessors of premises used to conduct the event ("Releases") .WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASES OR OTHERWISE, to the fullest extent permitted by law. Please type your name to agree to the agreement
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Please type your full name in this box to agree
How did you hear about Celiac Strong Camp?
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Please let us know how exactly you found out about Celiac Strong Camp. For example: Celiac Walk in Rochester, Celiac Walk in Syracuse, Celiac Walk other, Facebook search, yahoo search, google search, which bakery or vendor, friend, etc. Thank you.
Do you have family at camp this year?
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Yes
No
If yes, name(s) and relationship(s) to you
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For example: Joan Applejack, wife Kelly Bean, daughter
Name of Emergency Contact
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First
Last
[object Object]
Relationship to you
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Address of Emergency Contact
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Line 1
Line 2
City
State
Zip Code
Country
Home Phone for Emergency contact (area code and phone number, numbers only)
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Cell Phone for Emergency Contact (area code and phone number, numbers only)
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Work Phone for Emergency Contact (area code and phone number, numbers only)
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Name of Spouse or Partner
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First
Last
Relationship to Volunteer
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Address of Significant other
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Line 1
Line 2
City
State
Zip Code
Country
Home Phone for Significant other (area code and phone number, numbers only)
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Cell Phone for Significant other (area code and phone number, numbers only)
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Work Phone for significant other (area code and phone number, numbers only)
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If you are selected as a volunteer and cannot join us at camp, do you agree to reimburse Celiac Strong Camp for our costs, background checks of $25?
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Yes
No
Do you have any limitations that would keep you from activities at camp? If so, please explain:
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Any skills that may assist at camp such as life guard certification, registered nurse, or other training
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Comments / Notes
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Submit