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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 HIS KIDS Week-long Volunteer Application

Enter your name below as you would like it to appear on your nametag

Can you commit to the entire week of camp scheduled July 11-17, 2020?
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Do you have a valid driver's license?
Has your driver's license ever been suspended or revoked?
Do you use tobacco products?
If yes, are you willing to give this up entirely for one week?
Have you ever been terminated from any employment or volunteer service, or had any employment or authorization to hold a volunteer position denided, for reasons relating to allegations of actual or attempted sexual discriminations, 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?

How many years (if any) have you volunteered for Camp HIS KIDS? (LIT/CIT years do not count)

Have you or one of your siblings ever had cancer?
Are you able and willing to engage in the long hours (12+ hour days) and a physically demanding schedule that is required during your week at camp?
Do you have a central line?
Do you have any condition/s that would prevent you from picking up/carrying a child or pushing a wheel chair?
Are you CPR trained and certified?
Are you lifeguard trained and certified?
Are you currently under treatment for any medical or mental health issues?

In case of emergency, which hospital would you prefer to be taken to?

List any medications you will be taking at camp below (inc. dose & frequency)

List any allergies below (inc. meds/food/animals/insect stings, etc.) and please note the severity of the reaction. 

List any dietary restrictions and/or special food needs below.

Medical Conditions: Check those that apply

Please use the space below to provide details on items checked and/or to report medical conditions not listed. 

Have you ever had...
If you have not had chicken pox, have you been vaccinated for it?
Immunization information. Check all that apply as yes
Will you receive any vaccinations in the 30 days prior to camp?

NEW VOLUNTEER SECTION

The following 5 items apply only to new volunteers and to those who have not volunteered in the past 5 years. If this does NOT apply to you, scroll through these 5 items and continue below. 

1. How did you learn about becoming a Camp HIS KIDS volunteer?

2. Why do you want to be a HIS KIDS volunteer?

3. Describe any experience, training, education, or abilities you have which will help you  in your role at camp

5. Please list 3 references, including relationships to you, how long you have known the, and their contact information.

END OF NEW VOLUNTEER ONLY SECTION.

All applications, including new volunteers, please continue and complete below. Click SUBMIT at the end to complete your application when done. 

Please upload a photo file of your driver's license or state issued ID card below.

Upload File- license or ID
Max File Size 15MB

Please upload a photo of your medical insurance card below. NOTE- if you do NOT have medical insurance, this will not affect your eligibility to volunteer, but please note that in the space below so that we can update that in your emergency information.

Upload file-insurance card
Max File Size 15MB

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.

I verify that the information provided on this application is correct to the best of my knowledge and that there is nothing in my history which would call into question the legality or safety of me working with minors in this program

4. Is there anything else we should know about you that will be helpful to us when we select Camp HIS KIDS volunteers?