Volunteer Application

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* Required information.
Personal Information

APPLICATION DEADLINE IS MAY 1, 2017

Date of Application *Today's Date
Social Security Number *
Date of Birth *
Name * First, Middle, Last Name
Address *
City / State / Zip *
Phone Numbers - Home - Work - Cell *
Email Address *
T-Shirt Size

Transportation to and from camp will be provided at the Westside Community Education Center (3534 South 108th St), Departure time is 8:15 a.m., and will return at 4:45 p.m. daily.

Do you need transportation to and from camp? *
I will attend the mandatory orientation meeting and three days of camp *
Have you previously served as a camp volunteer for Camp Hot Shots? *
Why type position are you seeking at Camp Hot Shots? *

You must be a minimum of 16 years old to serve as a volunteer at Camp Hot Shots! Camp Staff under the age of 18 must attach a letter by their parent or guardian verifying your age.

Do you have any physical or mental disabilities that may prevent you from performing the esssential functtions of the position you are applying for? *If NO state NO. If Yes, please state your limitations and explain how we can accommodate your disability.
Education
High School / GED * State the name of the School you attended and the year you graduated
College * State the College you attended, the year you graduated and your Major.

Past Employment (list past two years)

Employer *Please state the name, address, term of employment, dates and reason for leaving
Employer *Please state the name, address, term of employment, dates and reason for leaving

Camp, Volunteer or Child Care Experience

Dates and Camp/Organization you have experience with. Please include your position and your supervisor and phone numbers *i.e.  00/00/00, name of organization. Supervisor, Contact information. Position you held
Additional Experience *
Provide name / address of 3 persons not related to you who have knowledge of your character, experience and abilitites *
What contributions do you feel you can make at camp in the lives of children with diabetes? *
Describe your experiences with special needs children and/or children with diabetes
What License do you hold? *
What states are you licensed in? *
Has your license ever been revoked? (If yes, explain) *
Do you have malpractice insurance covering your service at camp? *

Please mail a copy of your current license for the state in which camp occurs to:

Camp Hot Shots
P.O.Box 1731
Council Bluffs, Iowa 51502-1731