The 2015 DASH Form
What is your name?
Your answer
Who is your teacher?
Your answer
Address
Your answer
Phone
Your answer
Email
Your answer
Emergency Contact
Your answer
DASH Programs you are most interested in ?
What time of the year and the week are you most available? What is your foreseeable time availability for DASH on a monthly basis?
Your answer
Are you under the age of 18?
If you are under 18, please provide your date of birth?
Your answer
Have you ever been convicted of a violation of the law excluding minor traffic violations: Please begin typed answer with a Yes or a No If yes, please explain:
Your answer
Have you ever been convicted or accused of sexual or physical abuse of a minor? Please begin typed answer with a Yes or a No. If yes, please explain:
Your answer
What's your T-Shirt size?
Please tell us a little about yourself: background, current work / school involvement, etc:
Your answer
Tell us how you would self-reflect quickly address and respond to a situation where a camper does not listen to you, other staff or campers?
Your answer
Are there any sports or activities that you are particularly interested in?
Your answer
Please tell any experience you have relating to type 1 or type 2 diabetes or working with youth 8-18?
Your answer
What do you expect from the DASH team and how does DASH help you get to where you want to go in life?
Your answer
Typed Signature
Your answer
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