TEEN BOARD Volunteer Application
Thank you for your interest in becoming a BASE Camp Teen Board volunteer! Please fill out this application to register as an official BASE Camp Teen Board member.
First Name *
Your answer
Middle Name
Your answer
Last Name *
Your answer
Name you would like to be called, if different...
Your answer
Gender *
Date of Birth *
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Are you over the age of 18? *
T-Shirt Size *
Drivers License #
Your answer
Email Address: *
Your answer
Phone Number: *
Your answer
Permanent Address Line 1: *
Your answer
Permanent Address Line 2: *
Your answer
What school do you attend? *
Your answer
What county is your school? *
Your answer
Adult Adviser/Principal: *
Your answer
Adviser/Principal Contact Email: *
Your answer
School Address:
Your answer
School Phone Number:
Your answer
Do you have any present of previous volunteer experience? *
Please list any special skills, training or education:
second language, Computer skill, child care, etc...
Your answer
Are you a patient/sibling/child of a family member with a Hematological/Oncology Illness? *
If yes, what is your relationship with the patient?
Your answer
If you are the patient are you currently on treatment?
If you are the patient, what is your diagnosis?
Your answer
If you are the patient, what is the date of you diagnosis?
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