Summer Inclusion Camp Volunteer Application
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Peer Buddy's Information
Name *
(First Last)
Pronouns *
Date of Birth *
(Month/Day/Year)
Gender *
Name of Current School *
(If Transitioning, name transition school too!)
Street Address *
(Including City, State, and Zip Code)
What is the Peer Buddy's primary language? *
Is the Peer Buddy bilingual? If yes, please list additional language(s).
Please describe the Peer Buddy's current level of verbal language.
 *
If response to previous question was "No Verbal Language", please indicate:
Please describe the Peer Buddy's current level of reading comprehension skills.
 *
Does the Peer Buddy have any allergies? *
If "Yes", to what?
(Please List All)
What is the Peer Buddy's T-Shirt size?
(Adult/Youth, Size)
 *
How did you hear about us? *
Is the Peer Buddy OVER 16? *
If YES, List the Buddy's Phone Number
If YES, List the Buddy's Email Address
Parent/Guardian's Information
Name *
(First Last)
Relationship to Peer Buddy *
(Examples: Mother, Father, Grandfather, Nanny, etc.)
Primary Phone Number *
(Including Area Code)
Email Address *
Authorized Pick-Up (in addition to parents) *
(Include Name(s), Phone Number(s), and Relationship(s)
Emergency Contact's Information
Name of Emergency Contact *
(First Last)
Relationship to Peer Buddy *
(Examples: Mother, Father, Grandfather, Nanny, etc.)
Primary Phone Number *
(Including Area Code)
Summer Camp: Scheduling & Payment
Inclusion Camp is from July 8th-August 2nd, from 1:00-4:00pm, Monday-Friday.
The cost is $100 per camper per week for T-shirts, snacks, materials, and training.
Which week(s) would you like to sign up your child? *
(Multiple Weeks may be Chosen)
Required
What is your preferred payment method?

If the preferred payment method is unknown when completing this application, please select "Other" and explain. We highly encourage families to still apply even if their funding stream is not yet solidified so that their child's spot can be reserved. 
 *
Checks must be made payable to "PEERBUDDIES" and mailed to: 3463 State St. #275, Santa Barbara, CA, 93105 by June 1st, 2024.

Checks will then be processed in early July 2024.

If planning to pay by check, please type the Check Number here. 
If paying by Credit Card, please type Credit Card Number, CVN (3-digit code), Expiration month/year, Billing Zip Code, and Name on Card. *Please note 3.5% transaction fee will be added to the cost of camp for credit card transactions.
Important Registration Information

Please note that Peer Buddy volunteers must commit to all sessions in the week they
sign up for.  This is for several reasons:
1. Individuals with disabilities benefit from consistency;
2. Individuals with disabilities have difficulty coping with change;
3. The purpose of pairing children with the same buddy is to promote rapport.  Rapport is more likely to occur with consistent, repeated interactions.

Please note that you are signing up your child for one-week intervals.  As such, payments must be
made in full despite missed days.  Refunds will not be given for missed days.

All cancellations must be in writing, by mail or email at megan@peerbuddies.com.  

Cancellations received on or before May 31st, 2024 will receive a 100% refund. Cancellations received between June 1st and June 15th 2024 will receive an 80% refund. Cancellations received after June 15th are not eligible for a refund.

"I have read and understand all terms and policies listed above.  I hereby authorize PeerBuddies Camp staff to act for my child to the best of their judgement in any emergency requiring medical attention.  I hereby waive and release PeerBuddies staff from any and all liabilities for injuries or illness incurred while at camp.  I agree to direct my child to cooperate and follow directions and instructions from any PeerBuddies staff."

Please Initial to indicate you have read this and understand the terms.
 *
I understand that in the event my child must miss a day of camp, I will provide PeerBuddies with at least 24 hours' notice. *
Please Initial to indicate you have read this and understand the terms.
I allow PeerBuddies to videotape my child for the sole purpose of continuing education of PeerBuddies facilitators. (IN-OFFICE USE ONLY) *
Please type your initials.  If you do NOT wish for your child to be videotaped, type "do not consent".
I allow PeerBuddies to use video footage of my child on the PeerBuddies website, at professional conferences/trainings, and for research purposes. (OUT OF OFFICE USE) *
Please type your initials.  If you do NOT wish for your child to be videotaped, type "do not consent".
I allow PeerBuddies to take pictures for my child’s confidential client file. *
Please type your initials.  If you do NOT wish for your child to be photographed, type "do not consent".
I allow PeerBuddies to take pictures for publication according to the terms listed above. *
Please type your initials.  If you do NOT wish for your child to be photographed, type "do not consent".
Peer Buddy Questionnaire
Peer Buddy Candidates: Please answer all of the following questions as
completely as possible.  We're using this information to figure out who
your Buddy will be, so the more details you give us, the better we'll be
able to match you up!  
Why do you want to become a Peer Buddy? *
Have you volunteered before? *
If "Yes" above, please explain what you did.
What skills or attributes do you have that would benefit your Buddy? *
What are your favorite things to do?  Please list your hobbies and interests. *
How would you describe your personality? *
(Please select all that apply!)
Required
References
Please list one reference who has known you for at least 1 year and who
can speak to your character, personal qualities, and abilities.  This person
should be someone who has known you in a professional capacity
(i.e., a teacher, coach, employer, etc.)
Name *
(First Last)
Relationship to Applicant *
Primary Phone Number *
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