Camp Counselor Application

Application must be fully completed and submitted before consideration. 

Applicants under the age of 18 must complete a Junior Counselor application, and their parent or guardian must request that they be assigned as a counselor.
Counselor Personal Information

Counselor:
Address

Emergency Contact: 

Emergency Contact

Health Insurance Information:

Coverage for illnesses or injury while participating in programs at Camp Dream is the responsibility of the parent or guardian of the participating Counselor. Please provide medical/hospital insurance coverage information below. 

Health Condition 

We are entrusted to provide a safe and healthy environment for all of our campers. To aid us in accomplishing this goal, we ask that each applicant inform us if they have any medical conditions. 

SPECIAL NOTE: Inform the Camp director immediately if you are exposed to any communicable disease (chicken pox, mumps, measles, flu etc) within one month of the camping session.

The nurses will dispense all medications. All medications brought onto the premises must be checked in to the nurse and kept locked in the medical cabinet for the safety of the campers. Please list all prescription AND over the counter medications that you take. 

Certifications

Criminal Background

Experience

Personal References
Please give the names, email address and phone numbers of three persons not related to you, that you have known at least one year we can contact for references.

Reference 1
Reference 2
Reference 3

Affirmation and Consent

I hereby affirm that all information given is true and complete. By signing below, I warrant that all information entered within this application is complete and accurate. I understand and agree that if I have misled Camp Dream Foundation, my application and/or staff position will be terminated immediately. 

Liability

I am assuming the responsibility as counselor for campers assigned to me for the duration of the camping sessions chosen herein above. I release, absolve, indemnify, and hold harmless Camp Dream Foundation and its affiliates. In case of injury to myself, I hereby waive all claims against Camp Dream Foundation and its affiliates. I also acknowledge that all information provided in this application is to be kept confidential.

I release and waive any potential future claims against Camp Dream Foundation and its affiliates, employees, staff, and volunteers for any property damage and/or personal injury arising out of any activity connected with this camping session and/or use of camping facilities, including by way of example only and without limitation, transportation to and from events, use of facilities and equipment, and negligence of any person or entity. 

Consent to Perform Criminal Background Checks

I agree that by submitting this application, I am granting the Camp Dream Foundation permission to perform background checks to ensure the safety of the campers. Background checks may include, but are not limited to criminal background checks, driver’s license validation and sex offender listings. 

Photographs, Likenesses, Images and Recordings

I give my consent to Camp Dream Foundation, Inc. to photograph and/or make video or audio recordings of me without limitation and to use such photographs, videotapes or audiotapes and my name, likeness and voice and/or any related stories (“Likeness”) in connections with any of the work, programs, projects, fundraising or other endeavors of Camp Dream in any and all media, including without limitation, electronic or digital media, whether known or unknown at this time, forever worldwide and without restriction, without consideration or compensation of any kind. I release, discharge and hold harmless Camp Dream Foundation, Inc. and its affiliates, including, without limitation, its officers, directors, shareholders, employees, agents and contractors (“Camp Dream”) from any and all claims and demands arising out of or in connection with the use of my Likeness, Including slander, libel, invasion of privacy or publicity, and/or copyright infringement . This Release applies to me and my heirs, legal representatives and assigns and I do release, discharge and hold harmless Camp Dream Foundation, Inc. from any claim or demand whatsoever arising out of or in connection with such use. 
Diminished Capacity Waiver

Camp Dream is designed and intended to accommodate campers with mental and physical disabilities. Due to their diminished capacity, campers can be unpredictable. Campers will occasionally engage in conduct which may be considered rude, vulgar or socially inappropriate. This type of behavior may cause staff members and volunteers to feel uncomfortable, embarrassed and/or offended. While Camp Dream tries to minimize these types of incidents, it is impossible to eliminate them completely.

I acknowledge the specific risk of being exposed to conduct that I find offensive, rude, vulgar or otherwise beyond the norms of society. By signing this application and agreeing to volunteer at Camp Dream, I expressly assume the risk that Campers may engage in such conduct. In consideration for being allowed to volunteer at Camp Dream, I release and waive any potential future claims against Camp Dream, its employees and staff, including volunteers, that may arise due to the actions of campers during the sessions chosen herein above.


By signing and dating below, I give consent and acknowledge all of the above stated policies.