Summer Camp - Junior Counselor Application

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Applicants between the ages of 16 and 18 desiring to be a Counselor, must complete this application and their parent or guardian must request that they be assigned as a Counselor.

Session

Summer Camp (7/12 - 7/16)Summer Camp (7/16 - 7/20)Both Summer Camps (7/12 - 7/20)

Parent/Guardian 1 Information

First Name:

Last Name:

Relationship to Junior Counselor:

ParentGuardian

Email:

Cell Phone:

Home Phone:

Mailing Address

Street:

City:

State:

Zip:

County:

Facebook?

YesNo

Facebook URL:

Instagram?

YesNo

Instagram URL:

Add Parent/Guardian 2

Parent/Guardian 2 Information

First Name:

Last Name:

Relationship to Junior Counselor

ParentGuardian

Email:

Cell Phone:

Home Phone:

Same Mailing Address

YesNo

Mailing Address of Parent/Guardian 2

Street:

City:

State:

Zip:

County:

Emergency Contact Information (must be different than parents/guardians listed above and 18 years old or older)

Name:

Relationship to Junior Counselor:

Email:

Cell of Emergency Contact:

Home Phone:

Other Phone:

Personal References (must be different than parents/guardians listed above)

Provide three personal references over the age of 18 that can vouch for your work ethic and character.

Reference 1

Reference 1 Name:

Reference 1 Email:

Reference 1 Phone:

Reference 2

Reference 2 Name:

Reference 2 Email:

Reference 2 Phone:

Reference 3

Reference 3 Name:

Reference 3 Email:

Reference 3 Phone:

Health Insurance Information

Coverage for illnesses or injury while participating in programs at Camp Dream is the responsibility of the Junior Counselor’s parents or legal guardian. Please provide medical/hospital insurance coverage information below.

Carrier:

Policy/Group Number:

Policy Holder Name:

Health Condition

We are entrusted to provide a safe and healthy environment for all of our campers. To aid us in accomplishing this goal, we ask that each applicant inform us if they have any medical conditions.

Inform the Camp director immediately if you are exposed to any communicable disease (chicken pox, mumps, measles, flu, etc.) within one month of the camping session.

Mental Limitations?

YesNo

List All Limitations:

Physical Limitations?

YesNo

List All Limitations:

Allergies?

YesNo

Dietary Restrictions?

YesNo

List All Allergies:

List All Restrictions:

The nurses will dispense all medications. All medications brought onto the premises must be checked in to the nurse and kept locked in the medical cabinet for the safety of the campers. Please list all prescription AND over the counter medications that you take.

Any Medications During Camp?

YesNo

Medications

List all medications, dosages, and times medication is to be taken. Medications will be administered exactly as written below. Please be accurate and complete. You must provide all medications for your child. All medication must arrive in original container with the prescription label intact and legible. If no medications are taken, please write “none” for the name of the medication.

Medications To Be Given During Camp

Name of Medication

Medication Form

Dosage Times

Amount per Dose

Administration Notes

Certifications

Are you CPR certified?

YesNo

Expiration date:

Have you taken a first aid course?

YesNo

Expiration date:

Other relevant certifications and skills and experience. (e.g.- sign language, volunteer work,etc.):

Tell Us About You

How did you hear about Camp Dream?

Other

Friend of Camp or Former Camper

Which Internet Site:

Which Fair:

Name of Doctor:

Facebook, Twitter, etc.:

Have you been a Junior Counselor before?

YesNo

Where?

When?

The remaining questions in this section are optional, but help us to get to know you better.

Describe any experiences you have had that have prepared you to be a junior counselor and work with special needs kids.

Why do you want to be a junior counselor?

Summer Camp Manual Acknowledgement

Please visit https://www.campdreamga.org/summer-camp-manual to view a copy of the Camp Dream Summer Camp Manual. After you have read it, please read the below and sign your initials at the bottom.

I acknowledge that I have received a copy of the Camp Dream Summer Camp Manual (Manual). I understand that the Manual outlines the operation of the Camp Dream Summer Camp program.

I understand that the working conditions, policies, processes and procedures described in this Manual are confidential and may not be distributed in any way nor discussed with anyone.

I have read and understand the contents of this Manual and will act in accordance with these policies and procedures as a condition of my association with Camp Dream.

I have read and understand the Rules and Standards of Behavior expected by Camp Dream and I agree to act in accordance with the standards of behavior as a condition of my association with Camp Dream.

I understand that if I have questions or concerns at any time about the Manual, I will consult the Summer Camp Director(s), the Program Director, or the Executive Director for clarification.

Finally, I understand that the contents of the Manual are simply policies and guidelines, not a contract or implied contract with Volunteers. The contents of the Manual may change from time-to-time.

By placing my initials below, I acknowledge that I have read, understand and will comply with all conditions contained within the Manual.

Initials:

ATTENTION: Junior Counselors, Parents/Guardians, and all pertinent parties.

First and foremost, the Camp Dream Foundation would like to express how extremely grateful it is for every participant who chooses to help us in furthering our mission to improve the quality of life for children and young adults with special needs through operation of Summer Camp and Camp Out programs, and other recreational and educational activities. Moreover, we would like to ensure you that we do everything within our power to provide a safe environment for you while volunteering.

You will be provided a room in one of our cabins which you are expected to stay in. Your room assignment cannot be changed by anyone other than our Camp Director campdirector@campdreamga.org. If you have concerns with your room assignment, please see the Camp Director immediately.

Junior Counselors will not be responsible for campers. However, you may be assigned to help a Counselor with a camper, but will not be responsible for the camper at any time. Please be advised that should you have any issues while at camp we will do our best to resolve them as quickly as possible. In order for your concerns to be addressed you must report them to the Camp Director immediately.

Participant's Initials:

Parent/Guardian's Initials:

Liability

I am assuming the responsibility as a Junior Counselor for the duration of the camping session(s). I, together with my heirs, successors, beneficiaries and assigns (hereafter “Volunteer”), hereby release, absolve, indemnify, and hold harmless Camp Dream Foundation and its affiliates, including without limitation, employees, officers, directors, staff, assigns and volunteers (“Affiliates”). In case of injury or illness to myself, I hereby waive all claims against Camp Dream Foundation and its Affiliates. I also acknowledge that all information provided in this application is to be kept confidential.

Volunteer hereby releases and waives any potential future claims against Camp Dream Foundation and its Affiliates for any property damage, illness, death and/or personal injury arising out of or relating to any activity connected with this camping session and/or use of camping facilities, including by way of example only and without limitation, transportation to and from events, use of facilities and equipment, and negligence of any person or entity.

In addition to any other risks posed by participating or volunteering with Camp Dream Foundation, Volunteer understands that, despite any safety precautions being taken by Camp Dream Foundation, by participating or volunteering, there is a risk of potential exposure to COVID-19 or any other harmful virus or bacteria, which may result in illness or death. Volunteer releases, forever discharges, indemnifies and holds harmless Camp Dream Foundation and its Affiliates from any and all liability, claim, costs or expense related to such risk.

The above liability waiver and release will be governed by the laws of the state of Georgia and in intended to be read as broad as inclusive as permitted by such laws.

Participant's Initials:

Parent/Guardian's Initials:

Photographs, Likenesses, Images and Recordings

I give my consent to Camp Dream Foundation, Inc. to photograph and/or make video or audio recordings of me without limitation and to use such photographs, videotapes or audiotapes and my name, likeness, and voice and/or any related stories (“Likeness”) in connections with any of the work, programs, projects, fundraising or other endeavors of Camp Dream in any and all media, including without limitation, electronic or digital media, whether known or unknown at this time, forever worldwide and without restriction, without consideration or compensation of any kind. I release, discharge, and hold harmless Camp Dream Foundation, Inc. and its affiliates, including, without limitation, its officers, directors, shareholders, employees, agents, and contractors (“Camp Dream”) from any and all claims and demands arising out of or in connection with the use of my Likeness, Including slander, libel, invasion of privacy or publicity, and/or copyright infringement. This Release applies to me and my heirs, legal representatives, and assigns. I do release, discharge, and hold harmless Camp Dream Foundation, Inc. from any claim or demand whatsoever arising out of or in connection with such use.

Participant's Initials:

Parent/Guardian's Initials:

Diminished Capacity

Camp Dream is designed and intended to accommodate campers with mental and physical disabilities. Due to their diminished capacity, campers can be unpredictable. Campers will occasionally engage in conduct which may be considered rude, vulgar or socially inappropriate. This type of behavior may cause staff members and volunteers to feel uncomfortable, embarrassed, and/or offended. While Camp Dream tries to minimize these types of incidents, it is impossible to eliminate them completely.

I acknowledge the specific risk of being exposed to conduct that I find offensive, rude, vulgar or otherwise beyond the norms of society. By signing this application and agreeing to volunteer at Camp Dream, I expressly assume the risk that Campers may engage in such conduct. In consideration for being allowed to volunteer at Camp Dream, I release and waive any potential future claims against Camp Dream, its employees, and staff, including volunteers, that may arise due to the actions of campers during the session(s) I am signed up for.

Participant's Initials:

Parent/Guardian's Initials:

**Summer Camp Electronic Device Policy**

To foster a positive, distraction-free environment, we maintain a strict policy regarding the use of electronic devices during camp activities. This includes, but is not limited to, cell phones, tablets, laptops, and gaming devices.

1. **No Electronic Devices During Camp Activities:** Volunteers are not permitted to use electronic devices during scheduled camp activities, meals, or group events for anything other than camp related items (e.g. taking picture, messaging camper parents, or checking schedules/time). Devices should remain safely stored during these times.

2. **Requests to Put Away Devices:** If a volunteer is observed using an electronic device when they should not be, they will be asked to put it away. If a volunteer is asked to put their device away multiple times, on the third time, they will face immediate dismissal from camp and will be required to find transportation from camp premises.

3. **Emergency Use:** If a volunteer needs to contact home or staff in an emergency, they may request permission to use their device or utilize a camp staff member's assistance.

By following this policy, we aim to create a fun, safe, and immersive camp experience for everyone.

Initials:

Want to be a Counselor In Training instead of a Junior Counselor?

Junior Counselors are vital to the running of our camping session. However, we understand that some of you would like to take on more responsibility. You must be at least 16 in order to be a Counselor In Training. If you wish to be a Counselor In Training, please be aware that this includes you being responsible for a Camper for the entire session. You may be required to bathe, feed, change clothes, and make sure medications are taken (with the help of the medical staff). The Camp Director is the only staff member that can or will assign you a Camper. Not everyone that wants to be a Counselor In Training may be selected for that position. You will be advised upon arrival if you have been placed in the Counselor role.

PARENTS/GUARDIANS/PARTICIPANTS: Volunteering to be a Counselor In Training is an immense responsibility and therefore is not something that should be entered into lightly. However, on balance, with greater responsibility comes a much more edifying experience. If you are confident of your child's ability to accept such a responsibility please acknowledge so with your initials/signature below.

Counselor In Training Liability
I am assuming the responsibility as a Counselor In Training for a Camper assigned to me for the duration of the camping session. I release, absolve, indemnify, and hold harmless Camp Dream Foundation and its affiliates. In case of injury to myself, I hereby waive all claims against Camp Dream Foundation and its affiliates. I also acknowledge that all information provided in this application is to be kept confidential.

I release and waive any potential future claims against Camp Dream Foundation and its affiliates, employees, staff, and volunteers for any property damage and/or personal injury arising out of any activity connected with this camping session and/or use of camping facilities, including by way of example only and without limitation, transportation to and from events, use of facilities and equipment, and negligence of any person or entity.

Counselor In Training Affirmation and Consent

I hereby acknowledge and provide my permission for the Applicant to be a Counselor In Training. I understand that he/she will be subject to see or hear things that he/she may not be subject to in his/her everyday life as aforementioned herein (Diminished Capacity).

Participant's Initials:

Parent/Guardian's Initials:

Application Affirmation and Consent

I hereby affirm that all information given is true and complete. By signing below, I warrant that all information entered with this application is complete and accurate. I also warrant that I have legal authority to grant the rights granted above. I understand and agree that if I have misled Camp Dream Foundation, my application and/or staff position will be terminated immediately.

Participant's Signature:

Parent/Guardian's Signature:

Today's Date:

Contact ID

Account ID

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