Volunteer Aplication

Name * First Last
Date of Birth * / MM / DD YYYY
Are you a teen looking for community service hours? * Yes No
Address *
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Primary Phone * - (###) - ### ####
Secondary Phone - (###) - ### ####
Email *
Emergency Contact Name * First Last
Emergency Contact Relationship *
Emergency Contact Phone * - (###) - ### ####
Gender *
Have you ever been convicted, found guilty, entered a plea of nolo contendere (no contest), entered into a deferred prosecution or pre-trial intervention agreement, or had adjudication withheld in a criminal offense other than a minor traffic violation? (DUI is not a minor traffic violation.) Are there any criminal charges now pending against you? PLEASE CHOOSE ONE *
Where Arrested: Date(s):
Nature of Charge(s):
I understand that the program reserves the right not to place me or to discontinue the use of my services as a volunteer. Volunteer Signature - Please type your full name (This constitutes a legal signature) *
**All volunteers must commit to the entire weekend of camp, Friday March 26(2:00pm) thru Sunday March 28(12pm) ** Volunteer Status *

Please specify below
Please specify your volunteer status from the question above *
T-Shirt Size *
Area of Interest

Please rank the following volunteer areas in order of interest, one (1) being your highest preference, three (3) being your lowest preference. All volunteers must commit to the entire weekend of camp.
Family Pal - A Family Pal volunteer is paired with a family with a child age 12 or younger. Family Pals accompany that family (specifically the children) throughout the camp weekend.

A Family Pal volunteer is paired with a family with a child age 12 or younger. Family Pals accompany that family (specifically the children) throughout the camp weekend.
Cool Inspiring Teens (CITs) Assistant - CITs is a brand new group for teenage campers age 13 and up. CIT Assistants will accompany the group throughout the weekend.

CITs is a brand new group for teenage campers age 13 and up. CIT Assistants will accompany the group throughout the weekend.
Administrative Support - An administrative support volunteer helps with “behind the scenes” logistics, such as pre-camp program development, supply ordering, on-site camp registration, photography, and hospitality.

An administrative support volunteer helps with “behind the scenes” logistics, such as pre-camp program development, supply ordering, on-site camp registration, photography, and hospitality.
Getting to Know You

Please answer the following questions about yourself.
Are you an adult with a limb difference? *
What languages do you speak fluently?
What special qualifications or certifications (CPR, First Aid, etc) do you hold? *
Is there any other important information you feel H2L should know in considering your volunteer placement? *
Refereces

Please list one NON-FAMILY reference.
Reference Name * First Last
Reference Phone * - (###) - ### ####
Reference Relation *

Volunteer Aplication

Volunteer Aplication

Area of Interest

Getting to Know You

Refereces