PYE/Power of Hope Camp Volunteer/Staff Application Form

Whidbey Island, July 28 - August 4, 2019 (July 27th is a mandatory staff prep day)

This confidential form must be completed by applicants for any volunteer or staff position involving the supervision or custody of minors at the PYE/Power of Hope camp. This information helps us provide a safe and secure environment for youth who participate in our programs.

Please note: If you are from outside of Washington State, you will be required to submit a Criminal Background Check prior to the program start date. 
Contact information

If outside of USA or Canada, please enter City again

About You

This information is useful to us to ensure that we have a diverse/multicultural staff that reflects the needs of our youth.
Personal - Please list two people you have known for three or more years (other than family):

Work - Please list a past or present employer?

Medical and Emergency Information

Emergency Information

Transportation & Food

Consent to Basic Guidelines
These guidelines have been established for youth participants of this camp in order to create a safe and respectful environment for everyone. Please help youth follow them by adopting them yourself as well.
  • Refrain from coupling/sex
  • Refrain from using drugs or alcohol
  • Avoid violence

If you have any difficulty in submitting this form, please contact Susan Janow ( for assistance. Thank you.