*I will be 17 years of age at the beginning of my program
Yes No
*First Name:
*Last Name:
*Street Address:
*City:
*State:
Alabama Alaska Alberta Arizona Arkansas British Columbia California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New York Newfoundland and Labrador North Carolina North Dakota Northwest Territories Nova Scotia Nunavut Ohio Oklahoma Ontario Oregon Pennsylvania Price Edward Island Puerto Rico Quebec Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Yukon
*Postal Code:
*Country:
*Phone Number:
*Email Address:
*I am 18 Years of age or older:
Yes No
Date of Birth:
School or Business Address (If Applicable)
Street Address:
City:
State:
Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Postal Code:
Country:
Phone Number:
Email Address:
Employment (If Applicable)
Employer:
Position:
Medical/Health Insurance
*Do you carry Medical/Health Insurance?
Yes No
*If Yes, Carrier:
*Group Policy #:
*ID #
Gender
Gender:
Male Female
Choosing a Program
It is important to understand that we look for people with different experiences. You MUST
Information on the various programs can be found in the programs section of the web site. Some of the program descriptions may have changed since last summer.
Please select your top three choices for programs, with "1" being the highest. If you are selected, more detailed information about each specific program will be forwarded to you.
Note: All three choices are REQUIRED in order to complete this application.
*Choice 1:
Camp B&ST Camp Childhood USA I Camp Childhood USA II Camp FACT Teddi’s Team Doing A World Of Good Camp Courage (formerly Brain Tumor Family Retreat) RCSD Leadership Program
*Choice 2:
Camp B&ST Camp Childhood USA I Camp Childhood USA II Camp FACT Teddi’s Team Doing A World Of Good Camp Courage (formerly Brain Tumor Family Retreat) RCSD Leadership Program
*Choice 3:
Camp B&ST Camp Childhood USA I Camp Childhood USA II Camp FACT Teddi’s Team Doing A World Of Good Camp Courage (formerly Brain Tumor Family Retreat) RCSD Leadership Program
I would be interested in volunteering for year-round monthly programs in the following region(s):
Volunteer Position: Your volunteer responsibilities will be based upon the specific program's needs. The majority of volunteers are selected to serve as counselors with the campers in cabins. However, if there is a specific area in which you would like to volunteer, please indicate that below.
Have you attended any of our programs before?
Yes No
If yes, please indicate program(s) and year(s).
Where did you learn about Camp Good Days?
Do you know anyone involved in any of our programs?
Yes No
Name(s)
Certifications Any certifications you may have that will pertain to your volunteer activity must be current through September 2018 or later. Copies of all certification cards / licenses MUST be forwarded. FAX 585-624-5799 Attention Volunteer Coordinator.
*Mandatory: New York State Health Department requires ALL applicants to enclose a biography. We need to know about you, your experiences with Camp Good Days and Special Times, our programs, or anything that relates to your dealing with children who have special needs. Please include information on current certifications, areas of expertise, or any physical disabilities, which you may have, and how we may accommodate you.
*Brief Biography of max. 500 words
References
Give the names and addresses of 3 people (not relatives) having knowledge of your character, experience and ability.
References are required even for returning volunteers and former summer staff. Failure to do so will result in an unprocessed application.
Reference 1
Name:
Address:
Email
Phone:
Reference 2
Name:
Address:
Email
Phone:
Reference 3
Name:
Address:
Email
Phone:
Training New York Law requires that all applicants attend a training session prior to their camp session. Attendance is MANDATORY
Please Read Carefully:
I am a NEW volunteer and I will be attending the MANDATORY training on June 23, 2018 , at the Branchport, NY Recreational Facility
I am a RETURNING volunteer and I understand I must attend a training session on the day of or evening prior to the start of my program
*I have been charged or convicted of any crime involving children under 18 years of age
If you have, please explain:
All Camp Good Days medical forms will be completed online.
Once accepted into a program Camp Good Days will send you a link to its online medical forms, to the email address provided.
*I verify that I have read, understand, and agree to the statements written above.
