Thank you for your interest in becoming a volunteer with Camp Red Jacket at Lehigh Valley Health Network. When you complete the application form, click the submit button at the bottom.

Name and address

Please provide your complete name and address

Email address

***Please use a reliable email address. Correspondence will be sent to you via email frequently.***


Please enter the names of two NON-FAMILY references along with their phone number.

Demographic Information

Please provide the following information. Your age determines the requirements and clearances to volunteer at camp. Other information is only used to help us get a better idea of the demographic make-up of our volunteers.


What is your age on the first day of camp?

Interest in volunteering

Why do you want to volunteer with Camp Red Jacket?

Are you an employee of LVHN?

Criminal background - REQUIRED

Have you ever been CONVICTED of a misdemeanor or felony? Yes or No

If yes, please explain

Medical history - REQUIRED

Have you had the following diseases: Mumps, Rubella, Polio, Measles, Chicken Pox, tuberculosis? If you are 26 and under, you must have your medical provider fill out the Volunteer Health Certification Form provided in your packet of paperwork.

Emergency contact information

Please give us information on who we can contact in case of an emergency while you are at camp.

Camp Red Jacket Volunteer Program Requirements

I understand there are additional requirements necessary to be a LVHN Camp Red Jacket Counsellor. I will complete the required TB testing, obtain necessary clearances as instructed, paperwork and attend Camp Red Jacket orientation on or before the required deadlines.