Camp Volunteer Form
Diabetes Youth Services Hot Shots Camp is currently accepting applications to fill available volunteer positions. All volunteers must be at least 16 years old to volunteer. Please email camp@dys4kids.org with any questions.

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Email *
Legal First Name *
Legal Last Name *
Nickname
Date of Birth *
MM
/
DD
/
YYYY
Gender *
Address *
City/ State/Zip Code *
Phone Number *
T shirt Size *
Nutritional Information
Please answer to the best of your ability.
Do you have any allergies? *
If so, please specify.
Please indicate any other dietary restrictions you have.
Education and License Information
Please answer to the best of your ability.
List any certifications you currently hold (First Aid, Lifegaurd, etc). Put N/A if none. *
If you are in school, please list school, major, and anticipated graduation date (MM/YY). *
What license do you hold? *
Please provide your license number.
In what state are you licensed?
Has your license ever been revoked?
Clear selection
If yes, please explain.
Have you ever been accused of, convicted of, or had deferred adjudication of medical malpractice?
Clear selection
Do you have malpractice insurance covering your service at camp?
Clear selection
Availibity
Please answer to the best of your ability.
What camps are you interested in volunteering at? *
Have you attended Hot Shots Camp previously? *
Required
Current Employment and References
Please answer to the best of your ability.

Please list only professional references.
Name of Current Employer *
Address of Current Employer *
Phone Number of Current Employer *
Date of Employment *
MM
/
DD
/
YYYY
Reference #1 Full Name *
Reference #1 Phone Number *
Reference #1 Email *
Reference #1 Relationship *
Reference #2 Full Name *
Reference #2 Phone Number *
Reference #2 Email *
Reference #2 Relationship *
Additional Information
Please answer to the best of your ability.
Do you have Type 1 diabetes? *
Please list any physical restrictions you have.
Have you ever been convicted of a felony? *
What is your COVID-19 vaccination status? *
Do you have any special skills you think would be useful at camp? (Artist, singing, dancing, great jokes, etc.) *
Why do you want to volunteer at Hot Shots Camp? *
Liability Waiver
The above information is true to the best of my knowledge. I authorize investigation of all statements herein and release Diabetes Youth Services and all others from liability in connection with same. I understand that if employed, I will be an at-will employee. I understand that untrue, misleading, omitted information herein may result in dismissal, regardless of the time of discovery by Diabetes Youth Services

Waiver: In consideration of Diabetes Youth Services permitting me to participate at Diabetes Youth Services Camp, and acknowledging that activities while at camp have inherent risks, on behalf of my heirs, executors, administrators and assigns, I hereby waive, discharge, and release any and all rights claims for damages, losses or expenses which I may have against Diabetes Youth Service, Recreation Unlimited, Sylvania Park District/Olander Park, ProMedica Farms, or any other camp facility and their management, as well as any other person connected with Diabetes Youth Services Camps or as a result thereof. I hereby give Diabetes Youth Services, their legal representatives or assigns and those acting under their permission and upon their authority, permission to use my picture, and if desired, my name in advertising and in all forms of publicity, without limit as to time. I further release Diabetes Youth Services from any liability for what I might deem misrepresentation of be by virtue of alterations, optical illusions or faulty mechanical reproduction in such advertising and/or publicity.

 I further acknowledge that while Recreation Unlimited, Olander Park, and ProMedica Farms have COVID-19 protocols in place, and while DYS staff and volunteers also will be asked to follow COVID-19 protocols, DYS cannot guarantee that I will not contract COVID-19 while at a DYS camp or during registration and transportation to and from camp, and that there is an inherent risk of contracting COVID-19 by attending camp, and I hereby waive any liability against DYS for the same.

If you have any questions please contact:

Cindy Presser
Director, Program Development
419-291-1238
cindy@dys4kids.org
By typing my name below I understand Hot Shot Camp Terms and Conditions. *
Thank you for your interest in being a volunteer at Hot Shots Camp! A background check and drug screen are mandatory to be considered a camp volunteer.
Application deadline is April 15, 2024. After the deadline you will be contacted with more information.
A copy of your responses will be emailed to the address you provided.
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