2016 Celiac Strong Camp Registration

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 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 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.

* Indicates required field

Name *

First

Last

Your Gender *

Age on 8/9/2017 *

Date of Birth (MO/DY/YEAR) *

Email to be used for primary communication *

Address *

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City

State

Zip Code

Country

Primary Phone Number (area code and phone number, numbers only, EXAMPLE 5852300363) *

Cell Number (area code and phone number, numbers only) *

T-shirt Size (in August) *

This will be my ______ year at camp *

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. *

Yes, Lactose Free Diet required No

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. *

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 *

How did you hear about Celiac Strong Camp? *

Do you have family at camp this year? *

Yes No

If yes, name(s) and relationship(s) to you *

Name of Emergency Contact *

First

Last

Relationship to you *

Address of Emergency Contact *

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City

State

Zip Code

Country

Home Phone for Emergency contact (area code and phone number, numbers only) *

Cell Phone for Emergency Contact (area code and phone number, numbers only) *

Work Phone for Emergency Contact (area code and phone number, numbers only) *

Name of Spouse or Partner *

First

Last

Relationship to Volunteer *

Address of Significant other *

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City

State

Zip Code

Country

Home Phone for Significant other (area code and phone number, numbers only) *

Cell Phone for Significant other (area code and phone number, numbers only) *

Work Phone for significant other (area code and phone number, numbers only) *

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? *

Do you have any limitations that would keep you from activities at camp? If so, please explain: *

Any skills that may assist at camp such as life guard certification, registered nurse, or other training *

Comments / Notes *

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