Celiac Strong Camp Inc
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Celiac Strong Camp Registration Form for Volunteers
We are pleased to be hosting Celiac Strong Camp for our 5th 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 in June 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 on August 8, 2018,
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.
Camp forms will be due: 6/30/18
Training will begin Wednesday, August 8, 2018
prior to camp check-in
at 10 am
Check-out will be: Saturday, August 11, 2018
at 2:00 PM
Please note, camp is located at Camp Cherith, located at 9534 Short Tract Rd, Hunt, NY 14846
All forms should be mailed to us at: Celiac Strong Camp Inc.,
C/O Sabrina DeVos, 4010 Dean Rd, Marion, NY 14505
Please note. This is a camp, no air conditioning and you will be sleeping in a rustic setting. This is a rustic camp setting and we 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 (MO/DY/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 (area code and phone number, numbers only)
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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 (area code and phone number, numbers only)
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T-shirt Size (in August, 2017)
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Adult Small
Adult Medium
Adult Large
Adult XL
Adult 2XL
Adult 3XL
This will be my ______ year at camp
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1st
2nd
3rd
4th
5th
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 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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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, Facebook search, yahoo search, google search, 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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Name of Emergency Contact
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First
Last
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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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Do you have any limitations that would keep you from activities at camp? If so, please explain:
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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
Any skills that may assist at camp such as life guard certification, registered nurse, or other training
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Comments / Notes
*
Submit