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SunKids Volunteer Application 2017
Summer is fast approaching with many opportunities to volunteer at Center for Developing Kids. SunKids is a three week summer program designed to provide a fun and safe summer camp experience for children 3-10 years of age and we rely on the help of our volunteers to make the program a success. Thank you for your interest in joining us. Please fill out the form below with your information and availability by Friday, June 2nd. Volunteers are accepted based on availability, past program experience, and promptness in completing this form. You will be notified of your acceptance as a volunteer and given your schedule by Friday, June 23rd.
Last Name *
Your answer
First Name *
Your answer
Age
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Email Address *
Your answer
Cell Phone Number *
Your answer
Home Address *
Your answer
Have you previously volunteered at Center for Developing Kids? *
Please indicate whether you volunteered for SunKids, Write-On, in the clinic, etc.
Your answer
What experience do you have working with children? *
Your answer
Week 1: Which sessions are you available to volunteer? *
Please note that priority will be given to volunteers who can commit to full weeks of camp.
Available 12-4pm
Not Available
Monday, July 10
Tuesday, July 11
Wednesday, July 12
Thursday, July 13
Week 2: Which sessions are you available to volunteer? *
Please note that priority will be given to volunteers who can commit to full weeks of camp.
Available 12-4pm
Not Available
Monday, July 17
Tuesday, July 18
Wednesday, July 19
Thursday, July 20
Week 3: Which sessions are you available to volunteer? *
Available 12-4pm
Not Available
Monday, July 24
Tuesday, July 25
Wednesday, July 26
Thursday, July 27
Emergency Contact Information
If you are under 18, please have a parent or guardian complete this portion
Persons authorized to be contacted in an emergency *
Please indicate 2 contacts, including: name, relationship to you, and phone number.
Your answer
Physician to be called in an emergency *
Please include name and phone number
Your answer
If physician cannot be reached, what action should be taken? *
Your answer
Medical Insurance Company and Policy Number *
Your answer
Please list all allergies and medications *
Your answer
I give permission for myself/my child to participate in sensory motor, craft, cooking, and video watching activities. In the event I cannot be reached in an emergency, I hereby give permission to the physician named above or the one selected by Center for Developing Kids and authorize a staff member to secure proper treatment for my child as named above. Center for Developing Kids may arrange for an ambulance or paramedic to take myself/my child to the above named physician or the nearest emergency hospital for such emergency treatment and measures as are deemed necessary for the safety and protection of my child, at my expense. I/we hereby agree to assume all responsibilities and risk and release Center for Developing Kids, its therapist, assistants, and volunteers free and harmless and indemnify them from all damages or liability including attorney's fees and costs for any injury to my child while in the care of the staff from the Center for Developing Kids. *
Please type your name as confirmation of your signature *
Your answer
If under 18, please include parent name as confirmation of your signature
Your answer
Thank you very much. We look forward to working together!
Katlyn Grossnickle and Rachel Buckner
SunKids Program Directors
katlyn@centerfordevelopingkids.com
rachel@centerfordevelopingkids.com
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