Camp Volunteer Application

Personal Information

* First Name

Middle Initial

* Last Name

* Date of Birth

* Street Address

Suite / Apartment

* City

State

* Zip/Postal

* Mobile Phone

Home Phone

* E-mail

Education and Experience

I have previously volunteered at Nicklaus Children's Hospital.

I have previously worked at Nicklaus Children's Hospital.

I am a current employee at Nicklaus Children's Hospital.

Are you presently a student?

Are you currently employed?

Are you currently certified in any of the following?

List and describe any previous volunteer and/ or camp experience you may have:

List any skills, interest, hobbies, or experiences you have had with children

* Camp Preference

T-Shirt Size

Emergency Information

* Emergency Contact

* Relationship

* Mobile Phone

Home Phone

References

* Reference Name #1

* Reference #1 Relation

* Phone (Mobile)

* Reference Name #2

* Reference #2 Relation

* Phone (Mobile)

Camp Commitment

I understand that my service is important to the camp's success. I promise to serve the hours assigned and if I cannot be at the camp, I will promptly inform the camp coordinator.

* I understand

Have you ever been convicted of a criminal offense, had adjudication of a crime, withheld or pled nolo contendere (no contest) to a crime including but not limited to robbery, embezzlement, forgery, perjury, drugs, tax evasion, assault, battery, abuse, or any criminal offense involving dishonesty, breach of trust, or violence toward children:

Yes/Explain

**A Criminal Arrest & Conviction record search is made of all prospective volunteers of the hospital. A conviction or arrest record is not necessarily a bar to acceptance as a volunteer; factors such as age at the time of the offense, seriousness, and nature of the violation and rehabilitation will be taken into account. However, concealment of any conviction on this application shall be cause for discharge whenever discovered.

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Please use your mouse or your finger to sign:

(By signing this application I acknowledge the above information is true and correct)

This hospital fully complies with the Age Discrimination in Employment Act pf 1968 and the Civil Rights Act of 1964 which prohibits employment discrimination based on race, color, creed, sex, age, national origin, physical disability, or veteran status.