2018 Returning Volunteer Staff Application

Transcription

1 2018 Returning Volunteer Staff Application Camp is a life-changing experience. Thank you for your interest in volunteering at Camp UKANDU. We are currently looking for uniquely qualified candidates to help create yet another memorable year for more than 100 families touched by pediatric cancer. Approximately 80 volunteers will be selected as counselors, program staff, and medical staff to volunteer at Camp UKANDU this year. The mission of Camp UKANDU is to bring joy and hope to children living with cancer, their siblings, and their families through outrageously fun camping experiences. This application packet is to be used by people who have volunteered at Camp UKANDU within the past three summers (2015, 2016, and/or 2017). If you have never volunteered at Camp UKANDU, or if it has been more than three years since your last year (week) as a volunteer, please fill out a New Volunteer Staff Application. Camp UKANDU 2018 is located at YMCA Camp Collins, in Gresham, OR. Some recreational staffing will be provided by the YMCA Camp Collins camp facility. Camp UKANDU does not discriminate on the basis of race, color, religion, gender, gender expression, sexual orientation, age, national origin (ancestry), disability, marital status, military status, or any other characteristic protected by law in the volunteer selection process or in any of its activities. We are committed to providing an inclusive and welcoming environment for all of our volunteers, medical staff, parents and campers. IMPORTANT DATES & CONTACT INFORMATION: Volunteer Staff Training MANDATORY FOR ALL VOLUNTEER STAFF Saturday, June 16 th, Sunday, June 17 th, 2018 Training/setup will continue Sunday morning, and campers will arrive immediately following lunch. Camp Dates: Sunday, June 17 th, 2018 Saturday, June 23 rd, 2018 Campers begin staggered departure at 10:30AM Saturday. Staff plan to depart by 1:00PM. Please return your completed application by Wednesday, January 31 st 2018 to: Jason Hickox Camp UKANDU - Executive Director 601 SW 2 nd, Suite 2300, Portland, OR Phone: Fax: jhickox@campukandu.org 1

2 Camp UKANDU 2018 Returning Volunteer Staff Application Application Deadline: Wednesday, January 31 st, 2018 Camp Name: Name [first, last] Current Address: Street City State Zip Cell Phone Alternative Phone Address Date of Birth / / Gender Identity: Female Male Other Other Camp Experience [where & when]: Weeks of experience at Camp UKANDU (if none, leave blank): # of Camp UKANDU Teen Retreats (if none, leave blank): Unisex shirt size: XS S M L XL XXL XXXL XXXXL Are you a cancer survivor (optional) Yes No If yes, date of diagnosis Ethnicity (optional) Are you multilingual? Fluent Languages: Education: High school: Name of School: Year Graduated College: Name of School: Year Degree Received Graduate School Status or Degree Earned: Medical training List institutions, medical degrees, certifications, etc., & year received: 2

3 VOLUNTEER HEALTH INFORMATION Applicant Name: Local Emergency Contact: Address: Relationship: Home Phone: Work Phone: Health care provider name and contact number: Health History: Have you had - Mumps? YES NO Diabetes? YES NO Measles? YES NO Heart Problems? YES NO Asthma? YES NO Seizures? YES NO Immunizations History: Verify the following immunizations are up to date by CIRCLING: DPT Series Polio Booster MMR (Measles, Mumps, Rubella) Last Tetanus Booster (DATE REQUIRED) (It is strongly suggested that if it has been over 10 years since your last tetanus booster, that you have one before coming to camp this summer.) Allergies: Do you have allergies to: Hay Fever? YES NO Insect Stings? YES NO Medications? YES NO (Please specify & list symptoms): List any other allergies you have than have not been mentioned: Medications: Please bring all medications in original containers. You will turn in your medication and schedule to the nursing staff during training at Camp Collins. Restrictions: Do you have any restrictions relating to: Diet, including food allergies? Swimming? Activity level? Please describe any current physical, mental or psychological conditions requiring medication, treatment, or special restrictions or considerations while at camp. 4

4 VOLUNTEER AREAS Counseling Staff: Responsible for the safety and wellbeing of a group of approximately 7-11 campers. Counselors work on a team with one to three co-counselors. Male counselors reside in a cabin with male campers, and female counselors reside in a cabin with female campers. *The approximate age groupings of campers in the cabins are: 8-9; 10-11; 12-13; 14-15; 16-18; **LIT s (Leaders in Training) **LIT s are not campers. The leaders of this group coordinate a program for the participants focused on wellrounded learning opportunities to help them prepare for a possible transition onto staff. LIT Leaders are expected to plan and prepare program materials, schedules, and goals prior to camp. Program Staff: Responsible for preparing and leading program activities for campers. This includes planning the activities prior to camp and providing supply lists to the Management Team in advance. Most, but not all, program areas have a team of at least 2 staff. *The programs include (but are not limited to): games; arts & crafts; therapy dog(s) provider; weaving; music; pool side assistance; horse/corral assistance; cabin snacks; newspaper; photography; videography. Medical Staff: Responsible for providing medical care to campers and staff, both routine and specific. Medical staff work with a team of doctors, nurses, nurse practitioners and mental health professionals. *Please note that Pediatric Oncology RN s, Physicians, and Nurse Practitioners will be staffed in these positions. Rainbow Connection, a team of mental health professionals, consists of licensed professionals with a Masters in Social Work, Counseling, or other equivalent education and experience. (*Please include a copy of your license(s) and relevant certifications with this application.) Management Staff: Responsible for planning, organizing, and implementing the camp program. The Management Staff work as a team to help prepare Counseling, Program, and Medical Staff for the week of camp. The Management Team meets regularly throughout the year. During the week of camp, the Management Team s primary responsible is to provide support to Counseling, Program, and Medical Staff to provide the highest quality program for the campers. *Management roles include: Counseling Manager (primarily supports counseling staff); Program Manager (primarily supports program staff); Activities Manager (primarily plans, organizes, and implements all camp and teen activities); Stage Manager (primarily plans, organizes, and implements campfire programs (supporting Music Staff), announcements, & flag times) 3

5 VOLUNTEER AREAS cont. Please indicate which staff area(s) you are most interested in being a part of. If you are interested in multiple areas, please specify an order of preferences. Within your area(s) of interest, please list your specific choices in preference order. * Please note that we have limited volunteer spaces. There is no guarantee of acceptance or position. If selected to be a member of the 2018 Camp UKANDU volunteer staff team, we will do our best to place each person where they are most interested in volunteering, and, where they will best serve the campers. Preferred Age Group COUNSELING Preferred Program Area PROGRAM Quailified Medical Position MEDICAL Doctor Nurse Mental Health Preferred Management Role MANAGEMENT

6 SKILLS SHEET Please mark the following: Put a L before the activities you can organize and lead as an expert. Put an A before the activities you have some experience in and can assist with. Note: you do NOT need to mark every activity Drama: Theater Storytelling Games: Field games Large Group Games Small Group Games No/Low Prop Games Initiatives Camp Programs: Horses Archery Rock Climbing Science Waterfront: Swim Lessons Lifeguarding Music: Singing Instrumental: Arts & Crafts: Weaving Drawing Painting Pottery Dance: Line Dancing Quare Dancing Hip Hop Barista Relevant Skills Not Listed: 5

7 EMPLOYMENT INFORMATION Current Employer Address City Position/Title Supervisor s Name Address State Zip Dates of Employment Phone Previous Employer Address City Position/Title Supervisor s Name Address Reason for Leaving State Zip Dates of Employment Phone Previous Employer Address City Position/Title Supervisor s Name Address Reason for Leaving State Zip Dates of Employment Phone Please list volunteer experience: Agency Position Supervisor Phone 6

8 REFERENCES Please list two references (not relatives, significant others, other Camp UKANDU volunteers, or room/house mates) who can be contacted to answer specific questions regarding your character, experience and ability. Please list one personal reference (family member preferred). Name Relationship to You Main Phone Alternate Phone Contacted by: Date Contacted: Notes: For Office Use Only Name Relationship to You Main Phone Alternate Phone Contacted by: Date Contacted: Notes: For Office Use Only Name Relationship to You Main Phone Alternate Phone Contacted by: Date Contacted: Notes: For Office Use Only 7

9 Please note: If the individual is a patient, a HIPAA Authorization Form is required in addition to this Media Release Form. MEDIA RELEASE FORM Individual s full name (printed): ( I/my or Individual ) Effective date of this release: Name of event/activity: Activities being performed: ( Activities ) Interview Photography Filming or video recording Audio recording Other (specify): Purpose: Name of Third Party ( Entity ) (if applicable): Use by CAMP UKANDU for purposes of marketing, advertising and fundraising, including printed or electronic publications, brochures, advertisements, website and other forms of media and social media. How Entity will use Activities: OR Entity is performing Activities on behalf of UKANDU (pursuant to a contract with UKANDU) This Media Release is made effective as of the Effective Date by and between Individual and CAMP UKANDU (UKANDU) and Entity, as defined above. I consent to participating in the Activities, including any recording of my image, and agree it can be used in accordance with this Release. I shall receive no compensation of any kind for this Release. I hereby authorize UKANDU and/or Entity and their respective officers, directors, employees, agents and contractors acting on its behalf, to use my image and likeness in any form of media, including still image photograph, voice audio, and/or video image, and to offer those images and/or recordings for use or distribution for the Purposes identified above without notifying me. I authorize UKANDU and Entity to use my name in connection with the images and/or recordings and to use, copy, reproduce, exhibit or distribute in any medium (e.g. print publications, video tapes, CD-ROM, Internet/WWW) those images and/or recordings. Neither UKANDU nor Entity is required to use any image and/or recording obtained and may discontinue using such images and/or recordings at any time. I understand that all negatives, prints, digital reproductions, recordings, and videotapes shall be the property of UKANDU and/or Entity and shall not be returned to me. I waive any rights, title, claims or interest I may have to control or approve of the use of my identity of likeness in any publication or media (printed or electronic) or other use of the images and/or recordings now or in the future, whether that use is known to me or unknown, and I waive any right to royalties or other compensation arising from or related to the use of the images and/or recordings. I hereby agree to release and hold harmless UKANDU and Entity, including their respective officers, directors, employees, agents and contractors from and against any claims, damages or liability arising from or related to the use of the images and/or recordings, including but not limited to any re-use, distortion, blurring, alteration, optical illusion or use in composite form, either intentionally or otherwise, that may occur or be produced in production of the finished product. I agree to release UKANDU and Entity and those acting pursuant to their respective authority from liability for any violation of any personal or proprietary right I may have in connection with any use of my likeness or image for any use described above. I have read the terms of this release and I understand it. Individual s signature*: Date: *If participant is under the age of 18, a parent s name and signature must be obtained consenting for the Individual. Parent/Legal Guardian s signature*: Date: Parent/Legal Guardian s printed name: