COMMUNITY SERVICES DEPARTMENT 2018 VolunTEEN Program Information

COMMUNITY SERVICES DEPARTMENT 2018 VolunTEEN Program Information The Anaheim Community Services Department provides teens, 13 17 years of age, the opportunity to give back to their community and earn service hours through the summer VolunTEEN Program. Teens can volunteer at various summer programs throughout Anaheim, including O.A.K.S. Summer Day Camp, Zombie Survival Camp, Tiny Tots Academy, Summer Nights Under the Stars at Pearson Park Amphitheatre, S.T.A.R.S. After School Program, and the Fun on Wheels Mobile Recreation Program. ELIGIBILITY Applicants must be 13 years of age and have completed the 5th grade. Anaheim residents and students of Anaheim schools will be given priority placement. REGISTRATION PROCESS 1. Submit a complete application packet to the Community Services Department at Anaheim City Hall (4th floor) or during an orientation. 2. Attend an orientation. All new and returning VolunTEENS MUST attend an orientation with a parent or guardian as part of the application process. 3. Submit TB clearance dated no more than 2 years (clearances dated 2016-present will be accepted). 4. First time applicants must be fingerprinted for background checks. Fingerprinting can be done by appointment at designated locations and dates, or at one of the orientations. See below for more details. Current TB Clearance & Fingerprinting Background Checks The Community Services Department is required to have volunteers TB clearance on file. Applicants are responsible for the cost of the test. State Law AB 1663 requires all recreation program volunteers be fingerprinted for a background check and cleared by the California Department of Justice before placement. Fingerprinting is available at no cost and must be completed by City of Anaheim staff. FINGERPRINTING APPOINTMENTS & LOCATIONS Appointments can be made by contacting the Volunteer Program Specialist at (714) 765-4994 or VolunteerOffice@anaheim.net. PLEASE NOTE: These dates are strictly for fingerprinting. There will be no orientation. Locations Dates Times East Anaheim Community Center 8201 E. Santa Ana Canyon Road, Anaheim 92808 Brookhurst Community Center 2271 W. Crescent Avenue, Anaheim 92801 Downtown Anaheim Community Center 250 E. Center Street, Anaheim 92805 Wednesday, April 4 Friday, April 13 Wednesday, April 18 Thursday, April 26 6:00 p.m. to 7:30 p.m. 3:30 p.m. to 5:00 p.m. 5:00 p.m. to 6:00 p.m. 5:00 p.m. to 6:00 p.m. REMINDERS: Fingerprinting is for new VolunTEEN Program applicants only. Returning VolunTEENS do not have to be fingerprinted. Applicants must bring a current government-issued photo I.D. card (state I.D., driver s license, passport) or a current year, school-issued I.D. card to their fingerprinting appointment. Page 1

ORIENTATION DATES & LOCATIONS Orientation will be followed by fingerprinting. PLEASE NOTE: Due to time restrictions, only a limited number of fingerprintings will be done on orientation nights on a first-come, first-serve basis. Locations Dates Times East Anaheim Community Center 8201 E. Santa Ana Canyon Road, Anaheim 92808 Brookhurst Community Center 2271 W. Crescent Avenue, Anaheim 92801 Downtown Anaheim Community Center 250 E. Center Street, Anaheim 92805 Tuesday, April 3 Saturday, April 7 Thursday, April 12 Saturday, April 21 Tuesday, April 17 Wednesday, April 25 Orientation 6 p.m. Fingerprinting 6:30-8 p.m. Orientation 1 p.m. Fingerprinting 1:30-4 p.m. Orientation 6 p.m. Fingerprinting 6:30-8 p.m. Orientation 10 a.m. Fingerprinting 10:30-1 p.m. Orientation 6 p.m. Fingerprinting 6:30-7:30 p.m. Orientation 6 p.m. Fingerprinting 6:30-7:30 p.m. SUBMISSION & DEADLINE Completed application packets will be accepted beginning Monday, April 2nd. Applications WILL NOT be accepted prior to this date. Completed application packets can be submitted in person at an orientation or fingerprinting appointment. They can also be dropped off or mailed to: Anaheim Community Services VolunTEEN Program 200 S. Anaheim Boulevard #433 Anaheim, CA 92805 The last day to submit a complete application packet is Friday, May 11th applications must be received by 5 p.m. to be considered. Partial or incomplete applications will not be accepted. ASSIGNMENT & HOUR CONFIRMATION LETTERS Assignment letters will be mailed the week of May 21st. At the end of the Program, all teens will receive a letter confirming the number of community service hours performed during the duration of the program. Hour confirmation letters will be mailed the week of August 27th. QUESTIONS & ADDITIONAL INFORMATION For questions or additional information, please contact the Volunteer Program Specialist at (714) 765-4994 or VolunteerOffice@anaheim.net Page 2

COMMUNITY SERVICES DEPARTMENT Summer 2018 VolunTEEN Program Application Please print clearly and legibly. Incomplete applications will not be processed. Last Name First Name Age Street Address City Zip Code Home Phone Cell Phone Email School: I am a returning VolunTEEN YES Year: New Applicant Adult Shirt Size: SMALL MEDIUM LARGE EXTRA LARGE Why are you volunteering? Parent/Guardian Last Name Parent/Guardian First Name Cell Phone Work Phone Email NEW APPLICANTS: I agree to be fingerprinted by the Volunteer Program Specialist for the required background check and understand I am responsible for submitting proof of TB clearance dated within the past two years. YES NO REQUIRED FOR ALL PROGRAM PARTICIPANTS: I understand there is a time commitment involved and I am responsible for transportation to and from my assignment. I also understand placement is not guaranteed upon applying and if I do not follow program guidelines, rules and regulations, I may be released from my volunteer assignment. Parent/Guardian Signature Date Participant Signature Return or mail completed applications to: Anaheim Community Services Attention: VolunTEEN Program 200 S. Anaheim Blvd. #433, Anaheim, CA 92805 Date For questions or more information: Phone: (714) 765-4994 Email: VolunteerOffice@anaheim.net FOR OFFICE USE ONLY Volunteer Assignment(s) Selection Page Hold Harmless Supplemental Questionnaire TB Clearance Parental Consent Photo Release Orientation/Code of Conduct Fingerprint Clearance Page 3

APPLICANT NAME: VOLUNTEER OPPORTUNITITIES REMINDER: Applicants must be able to commit to their selected schedule in its entirety. O.A.K.S. Summer Day Camp CHOICE # Oak Canyon Nature Center, 6700 E. Walnut Canyon Road, Anaheim 92807 Monday through Friday, 8:00 a.m. to 1:30 p.m. Assist Nature Center staff in providing day camp programming for children 5 12 years of age. Activities take place outdoors and include hiking, arts & crafts, games, science, and outdoor fun. Applicants must be 14 years of age and older in order to be placed in this assignment. Week 1 June 18-June 22 Week 4 July 9-July 13 Week 7 July 30-August 3 Week 2 June 25-June 29 Week 5 July 16-July 20 Week 8 Aug. 6-Aug. 10 Week 3 July 2-July 6 Week 6 July 23-July 27 Week 9 Aug.13-Aug. 17 Zombie Survival Camp CHOICE # Oak Canyon Nature Center, 6700 E. Walnut Canyon Road, Anaheim 92807 Monday through Friday, 8:00 a.m. to 2:30 p.m. Assist Nature Center staff in providing day camp programming for youth ages 10 14 years of age. Activities take place outdoors and include learning wilderness survival skills, archery, and hiking. Applicants must be 15 years of age and older in order to be placed in this assignment. Week 1 June 25-June 29 Week 2 July 9-July 13 Week 3 July 30-August 3 Summer Nights Under the Stars Family & Movie Nights CHOICE # Pearson Park Amphitheatre, 401 N. Lemon Street, Anaheim 92805 Friday evenings, varying times Assist theatre staff with set-up, ticket taking, arts & crafts, ushering duties, and take down. Applicants must select a minimum of two (2) dates. Friday, June 15 4 9 p.m. Friday, July 13 4 9 p.m. Friday, August 3 4 9 p.m. Friday, June 22 4 9 p.m. Friday, July 20 4 9 p.m. Friday, August 10 6 10 p.m. Friday, June 29 4 9 p.m. Friday, July 27 4 9 p.m. Friday, August 17 6 10 p.m. Tiny Tots Academy CHOICE # Various locations throughout Anaheim. Select one location. Varying days, 8:30 a.m. to 12:00 p.m. Select week(s) and days. Assist program staff and students, ages 3 5 years old, with arts & crafts, story time, learning activities, and outdoor play. Brookhurst Community Center 2271 W Crescent Avenue, Anaheim 92801 East Anaheim Community Center 8201 E Santa Ana Canyon Road, Anaheim 92808 Peralta Recreation Center 115 N Pinney Drive, Anaheim 92807 Wk. 1 June 18-22 M,W,F T, Th M-F Wk. 6 July 23-27 T, W, TH Wk. 2 June 25-29 M,W,F T, Th M-F Wk. 7 July 30-Aug. 4 T, W, TH Wk. 3 July 2-6 M,W,F T, Th M-F Wk. 8 August 6-10 T, W, TH Wk. 4 July 9-13 M,W,F T, Th M-F Wk. 9 August 13-17 T, W, TH Wk. 5 July 16-20 M,W,F T, Th M-F The following choices have moderately flexible schedules. Please indicate your summer availability in the space provided. East Anaheim Gymnasium CHOICE # 8165 E. Santa Ana Canyon Road, Anaheim 92808 Assist gymnasium staff with youth sports camps such as volleyball and basketball. Community Services Department Office CHOICE # 200 S Anaheim Boulevard #433, Anaheim 92805 Assist with office work. Hours will vary depending on need and/or assignment. Page 4

Anaheim Youth Centers CHOICE # Downtown 225 S. Philadelphia Street, Anaheim 92805 West Anaheim 320 S. Beach Boulevard, Anaheim 92804 Assist center staff with providing homework help, tutoring, and special programs and events. Indicate your summer availability: S.T.A.R.S. After School Program CHOICE # Different locations throughout Anaheim. Select one location. Monday through Friday, hours usually take place between 3-6 p.m. but vary by location. Assist program staff in providing homework help, games, sports, and recreational activities to youth 5-16. Brookhurst Park 2271 W. Crescent Avenue, Anaheim 92801 Juarez Park 841 S. Sunkist Street, Anaheim 92806 Twila Reid Park 3100 W. Orange Avenue, Anaheim 92804 Modjeska Park 1331 S. Nutwood Street, Anaheim 92804 Miraloma Park 2600 E. Miraloma Way, Anaheim 92806 Pearson Park 400 N. Harbor Boulevard, Anaheim 92805 Ponderosa Park 320 E. Orangewood Avenue, Anaheim 92802 Paul Revere Park 160 W. Guinida Lane, Anaheim 92805 Maxwell Elementary School 2613 Orange Avenue, Anaheim 92804 Patrick Henry Elementary 1123 W. Romneya Drive, Anaheim 9801 John Marshall Elementary 2066 W. Falmouth Avenue, Anaheim 92801 Select week(s) Wk. 1 June 19-June 23 Wk. 4 July 10-July 14 Wk. 7 July 31-August 4 Wk. 2 June 26-June 30 Wk. 5 July 17-July 21 Wk. 8 August 7-August 11 Wk. 3 July 3-July 7 Wk. 6 July 24-July 28 Wk. 9 August 14-August 18 Fun On Wheels Mobile Recreation Program CHOICE # Various locations throughout Anaheim. Select location(s). Schedules vary from site to site, but generally take place Monday Friday, 3 p.m. to 5 p.m. Assist program staff in providing homework assistance, fitness fun, and art enrichment to youth 5-18. Rio Vista Park, Anaheim 92806 Benmore Ln./Canfield Ln., Anaheim 92805 Mondays and Wednesdays Tuesdays and Thursdays Anna Dr., Anaheim 92805 Avon Pl./Dakota St., Anaheim 92805 Mondays and Wednesdays Tuesdays and Fridays Glen Ave./Neighbors Ave., Anaheim 92801 Kodiak St., Anaheim 92807 Mondays and Thursdays Tuesdays and Fridays Energy Park, Anaheim 92802 Alameda/Bronwood/Catalina, Anaheim 92801 Mondays and Thursdays Wednesdays and Fridays Balsam Ave./Curtis Ct., Anaheim 92806 Tuesdays and Thursdays Danbrook Elementary, Anaheim 92804 Wednesdays and Fridays Select week(s) Wk. 1 June 18-June 22 Wk. 4 July 9-July 13 Wk. 7 July 30-August 4 Wk. 2 June 25-June 29 Wk. 5 July 16-July 20 Wk. 8 August 6-August 10 Wk. 3 July 2-July 6 Wk. 6 July 23-July 27 Wk. 9 August 13-August 17 Page 5

CITY OF ANAHEIM MODEL CONSENT AGREEMENT & RELEASE OF LIABILITY (Minor Volunteer Form) In consideration of the engagement as a model of the minor named below, and for other good and valuable consideration herein acknowledged as received, I hereby grant to (photographer), City of Anaheim, their officials employees, volunteers, heirs, legal representatives, and assigns, those of whom Photographer is acting, and those acting with their authority and permission, the irrevocable and unrestricted right and permission to take, copyright, use, re-use, publish, and republish photographic portraits, pictures of me, or audio or video recording or in which I may be included, in whole or in part, or composite or distorted in character or form, without restriction as to changes or alterations, in conjunction with the minor s or a fictitious name, or reproductions thereof in color or otherwise, made through any medium and in any and all media now or hereafter known for illustration, promotion, art, editorial, advertising, trade, or any other purpose whatsoever. I also consent to the use of any published matter in conjunction therewith. I hereby waive any right that I or the minor may have to inspect or approve the finished product or products and the advertising copy or other matter that may be used in connection therewith or the use to which it may be applied. In exchange for the benefits derived by my participation in this project, I hereby agree that I, my heirs, distributees, guardians, legal representatives, and assigns do release and will indemnify, hold harmless and not sue the photographer, City of Anaheim, their officials, employees, representatives, agents, servants, or volunteers for any liability, claims, or actions for injury, death, or damage to personal property, claims for libel or violation of any right of publicity or privacy arising out of or in connection with my participation in the photography project, from whatever cause, including the active or passive negligence of the photographer, City of Anaheim, or their officials, employees, agents, representatives, volunteers, or project participants. I HAVE CAREFULLY READ THIS AGREEMENT AND FULLY UNDERSTAND ITS CONTENTS. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND SIGNED IT OF MY OWN FREE WILL. Print Minor s Name Parent / Guardian Name Parent / Guardian Signature Date Accepted by: City of Anaheim RM (3/ 09) Minor Photo Release Page 6

COMMUNITY SERVICES DEPARTMENT Parental Consent - Release For applicants under 18 years of age I,, am the Parent/Guardian of who is a minor (Parent / Guardian Name) (Minor s Name) and has applied for employment with or wishes to volunteer his/her services to the City of Anaheim Community Service Department. I understand and acknowledge that the City of Anaheim is required to comply with Public Resources Code Section 5164 which states that the City shall not hire a person for employment, or hire a volunteer to perform services in a city park, playground, recreational center, or beach used for recreational purposes in a position having supervisory of disciplinary authority over any minor if that person has been convicted of any offense specified in paragraph (1) of subdivision (h) of Section 11105.3 of the Penal Code or any offense specified in paragraph (3) of subdivision (h) of Section 11105.3 of the Penal Code. For purposes of this consent/release relating to the supplemental questionnaire, the term conviction(s) included adjudication(s) in juvenile proceedings under Welfare and Institutions Code. Completion of the attached supplemental questionnaire, successful completion of a background criminal records screening, including fingerprinting, and other background screening are required before Applicant may be deemed eligible to perform services for the City position for which he/she has applied. As the parent/guardian of, and having read the attached Supplemental Questionnaire, (Minor s Name) I hereby authorize and consent to s completion of the attached questionnaire (Minor s Name) and/or I have completed the questionnaire of behalf of. I further authorize and consent to the City of Anaheim performing a background criminal records screening, including fingerprinting, as well as any other background screening. I hereby hold harmless and release the City of Anaheim, it officers, employees, agents and volunteers from any and all claims, damages, actions and other liability relating to or resulting from completion of the above-referenced screening process. Signed this day of, 2018. (Today s Date) (Month) (Minor s Name) Print Minor s Name Parent / Guardian Signature Page 7

COMMUNITY SERVICES DEPARTMENT Child / Minor Hold Harmless, Release of Liability & Medical Authorization has my permission to voluntary participate in the Anaheim Community (Child / Minor s Name) Services Volunteer Program. I AM AWARE THAT PARTICIPATING IN THIS ACTIVITY CAN BE HAZARDOUS, AND I AM AWARE OF THE DANGERS INVOLVED WHICH MAY PLACE THE PARTICIPANT AT RISK FOR POSSIBLE INJURY, DEATH OR PROPERTY DAMAGE AND HEREBY AGREE TO ACCEPT ON BEHALF OF MYSELF AND MY CHILD, ANY AND ALL SUCH RISKS. I AM AWARE THAT, AS A VOLUNTEER, MY CHILD IS NOT COVERED FOR ANY WORKER S COMPENSATION BENEFITS, OR ANY FIRST PARTY HEALTH AND ACCIDENT INSURANCE BY THE CITY OF ANAHEIM. In exchange for benefits to be derived by my child s participation in the City of Anaheim s Community Services Volunteer Program, I HEREBY AGREE TO INDEMNIFY, HOLD HARMLESS AND NOT SUE THE CITY OF ANAHEIM, ITS OFFICERS, EMPLOYEES, REPRESENTATIVES, OR VOLUNTEERS for any liability, claims, or actions for injury, death, or damage to personal property arising out of or in connection with my child s participation in the City of Anaheim s Community Services Volunteer Program, activities from whatever cause including the active or passive negligence of the City of Anaheim, its officers, employees, agents, representatives, or volunteers. I hereby consent to allow my child to receive medical treatment which may be deemed advisable in the event of injury, accident or illness during my child s participation in this activity. I HAVE CAREFULLY READ THIS AGREEMENT AND FULLY UNDERSTAND ITS CONTENTS. I AM AWARE THAT THIS IS A HOLD HARMLESS AGREEMENT AND A RELEASE OF LIABILITY; AND IT IS A CONTRACT BETWEEN MYSELF AND THE CITY OF ANAHEIM, WHICH I SIGN OF MY OWN FREE WILL. Parent / Guardian Signature Date Child / Minor Signature Date Print Parent / Guardian Name Print Child / Minor Name Address (Street, City, Zip Code) Home Phone Number Work Phone Number EMERGENCY CONTACT Name Relationship Home Phone Number Work Phone Number FOR SITE USE: Accepted on behalf of the City of Anaheim Name Site Date Return the original copy to the Volunteer Program Specialist Page 8

CITY OF ANAHEIM PUBLIC RESOURCES CODE SECTION 5164 SUPPLEMENTAL QUESTIONNAIRE For applicants under 18 years of age, the signature of parents or guardians must be obtained on this form as well as on the attached Consent/Release form relating to fingerprinting. The California Legislature, through Public Resources Code Section 5164, has enacted a law requiring prospective employees or volunteers who wish to perform services at a city park, playground, recreational center or beach used for recreation purposes, in a position having supervisory or disciplinary authority over any minor to complete an application that inquires as to whether or not that prospective employee or volunteer has been convicted of any offense in Section 11105.3 of the Penal Code. For purposes of this supplemental questionnaire, the term "conviction" includes adjudication under the Welfare and Institutions Code. Please circle "Yes" or "No" to the questions below. If you answer "Yes" to any of the following questions, please provide in the spaces below, the date and location (including the state and/or country) of each such conviction, the specific Penal Code section involved, whether in California or out of State, whether the conviction was deemed a misdemeanor or felony, the specifics of the crime and the disposition. Please also be advised that employment in this position is contingent upon a criminal records check. This records check will require the person to provide his/her fingerprints. Please be advised that failure to give complete and accurate information may be grounds for rejection of this application; removal of your name from the eligibility list or dismissal from your position if hired. 1. Have you ever been convicted of a violation or attempted violation of Sexual Battery? YES NO 2. Have you ever been convicted of a sex offense against a minor? YES NO 3. Have you ever been convicted of any crime that would require you to register as a sex offender in California or anywhere else, including any federal or military court? YES NO 4. Have you been convicted or incarcerated within the last ten (10) years for abusing or attempting to abuse a child; and/or endangering or attempting to endanger the health of a child? YES NO 5. Have you been convicted or incarcerated within the last ten (10) years for willfully inflicting upon a child any cruel or inhuman corporal punishment or an injury resulting in a traumatic condition? YES NO 6. Have you been convicted or incarcerated within the last ten (10) years for: Theft YES NO Robbery YES NO Burglary YES NO 7. Have you been convicted or incarcerated within the last ten (10) years for any felony? YES NO If you have answered, "YES" to any of the above questions, please provide the date, location, state and country of each conviction as well as the specific Penal Code Section involved, the specifics as to the crime involved and the disposition. CERTIFICATION OF APPLICANT I hereby certify that all responses herein are true and correct, and I understand and agree that any misstatement or omission of material fact may cause forfeiture on my part of all rights to employment by this City. Applicant Signature (Or parent/guardian if applicant is under 18) Print Applicant Name Date Rev. 3/16/2012 /P:\Rec\SUPPORT SVCS & CUL ART.2\PERSONNEL\FORMS\Supplemental Questionnaire - March 2012.doc Page 9

CITY OF ANAHEIM COMMUNITY SERVICES DEPARTMENT FINGERPRINTING INFORMATION SHEET Transaction #: ORI: A1495 Type of Application: Employee Volunteer Job/Volunteer Location: BILLING: 140430 Mail Code: 08421 First Name: Last Name: MI: DOB: Gender: Male Female Height: Weight: Eye Color: Hair Color: City of Birth: State: Country: Address: City: Zip Code: FOR OFFICE USE ONLY Account: Completed By: Date: ATI Number: SID Number: Date SID Number was Received: Original: Personnel Specialist Yellow Copy: Supervisor Pink Copy: Staff/Volunteer P/Rec SUPPORT SVCS & CUL ART2/PERSONNEL/DOJ Rev 04/2013 Page 10