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PO Box 412, Highland, IL 62249, USA

Ph: (618) 654-4020- St. Louis

  (941) 302-8412-Florida

Fax: (618) 654 4499

Camp Nurse Application
For registered nurses who would like to stay at camp for the entire week, a couple days, or just help out for a day/half day to experience Camp HIS KIDS.
NOTE: Application is not complete until you click the "submit" button at the bottom of this application.

How would you like your name to appear on your camp name tag?

In which state/s do you hold a current nursing license?

Please indicate below which day/s and times you can be at camp. Our camp days typically begin around 7:30am and last until evening activities are finished around 8:30pm, but you do not have to stay the entire time.

Camp Dates:
Driver's license?
Has your driver's license ever been suspended or revoked?
Do you use tobacco products of any kind?
If yes, are you willing to give this up entirely while on-site at camp?
Have you ever been terminated from any employment or service in a volunter position, or had employment or authorization to hold a volunteer position denied, for reasons relating to allegations of actual or attempted sexual discrimination, harassment, exploitation, or misconduct; physical or sexual abuse of a child; or financial misconduct?
Is there any fact or circumstance involving you or your background that would call into question you being entrusted with the responsibilities of the position for which you are applying?

The Camp HIS KIDS cell phone policy is that we do not allow volunteers, staff, campers, or LITs to use cell phones or other electronic devices while at camp for the safety and security of our campers and staff. Because of medical needs, nurses and other medical staff will be able to use their cell phones for camper medical purposes. However, reception is spotty on some areas of the camp. If you need to be reached for emergency purposes, please give your contacts the HIS KIDS cell phone number: 618-654-4020 

Are you able to abide by the HIS KIDS cell phone usage policies for nurses while on-site at camp? If no, please explain below.

Are you willing and medically able to engage in the long hours (12+) days and a physically demanding schedule that is required during your time at camp?
Do you have any condition that would prevent you from picking up a child or pushing a wheelchair?
Are you currently under treatment for any medical or mental health issues?

Please upload a copy/photo of your most recent CPR certification and driver's license/state ID.

Upload CPR cert here
Max File Size 15MB
Upload License/ID here
Max File Size 15MB

I verify that the information provided on this application is correct to the best of my knowledge. 

In order to provide a safe and secure environment for those children and youth who participate in our programs, this form is to be completed by all applicants involved in the supervision or custody of minors (ages 18 and under).  We have profound legal and moral obligations to reduce the possibility of child abuse from ever occurring.  Adults who have been convicted of either child sexual or physical abuse should not volunteer service in any HIS KIDS sponsored activity or program for children or youth.  The information obtained through this application will remain confidential and only be seen by personnel needing to review this record for the HIS KIDS program or in the case of a legal investigation.

How many years, if any, have you previously volunteered at Camp HIS KIDS?