HPH CAMP REACH OUT - Volunteer Application 2020

Please complete this application form if you are interested in volunteering for Camp REACH OUT on March 6-8, 2020. Camp is a truly rewarding experience and fills up quickly, so we encourage you to apply early. Volunteers will be accepted based on previous experience, space availability, willingness to serve in a flexible capacity, skills and eligible background screening results. Incomplete applications will not be processed, so please complete all information. When complete, click the "I agree" button for your application to be submitted. A Camp Volunteer Coordinator will be in touch with you soon. Thank you!

For any questions please call 727-816-3647.

Name/address & other information:

First name:

Last name:

Middle name:

Title:

Nickname:

Street 1:

Street 2:

City:

State:

* Zip: *

Home phone:

Cell phone:

Email address:

How did you learn about us?:

* Are you a current Volunteer/Employee?:

Required Information

Your Social Security number and other information is required in order to perform mandatory background screening. Chapters Health, Inc. will keep your information private and transmits it directly to a secure, encrypted database that is password protected.

Date of birth:

Gender:

Driver's License/Gov't Issued ID #:

Social Security Number:

Camp Orientation Date (choose one):

* Availability:

Emergency Contact Information

Who should we call in case you have an emergency at camp?

First name:

Last name:

Home phone:

Cell phone:

Relationship:

Misc. Information

Have you had a recent personal loss/death that would make it difficult for you to focus on the children's needs? Please explain.

Misc Information

Do you have any special needs, allergies, dietary restrictions, physical limitations, etc.? Please explain your answer.

Misc. Information

Do you have a personal relationship with one of the children attending camp? If yes, please explain:

Skills/talents/other information

Do you speak another language and willing to help with translation? Please tell us what talents and skills you have that may benefit the children at camp and tell us any other info you would like us to know:

Role Preferences at Camp

We will make every effort to place you according to preference.

Cabin volunteers must be available all weekend and capable of attending activities with the campers.

Support Volunteers are assigned to specific activities and should choose more than one preference as each activity may not be offered at the camp you attend.

Check all that apply or interest you.

Volunteer Agreement

I acknowledge that by submitting this application, I agree that I will undergo a background screening and attend volunteer orientation before serving as a Camp REACH OUT volunteer. I certify that answers contained in this application are true and complete to the best of my knowledge. I understand that submission of this application is not a guarantee that I will be accepted as a volunteer. I understand that this application is not, nor is intended to be a contract of employment. In the event of becoming a Chapters Health System, Inc, Good Shepherd Hospice, HPH Hospice or LifePath Hospice volunteer, I understand that false or misleading information given in my application or interview(s) may result in dismissal. I also agree that I will abide by all rules and regulations of Chapters Health, Inc. and Camp REACH OUT.

I Agree