Summer Camp - Counselor Application

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As a camp counselor you will be paired either 1:1 or 1:2 with a camper and are essentially their buddy for the extent of the session. You will be responsible for helping with daily tasks such as feeding and dressing, but importantly, you are there to ensure they are safe and have fun.

Application must be fully completed and submitted before consideration.

Applicants under the age of 18 must have a parent/guardian complete a Junior Counselor Application instead of this Counselor Application.

For Applicants ages 16-17, the parent/guardian may request the Applicant be considered for the Counselor in Training (CIT) program. Counselor in training (CIT) is essentially a camp counselor; however, you will be paired with an experienced counselor who will be able to assist in any needs you may have.

Session

Summer Camp (7/12-7/16)Summer Camp (7/16-7/20)Both Summer Camps (7/12 - 7/20)

Certifications

Are you CPR Certified?

YesNo

Expiration date:

Have you taken a first aid course?

YesNo

Expiration date:

Other relevant certifications and skills (e.g. physical, occupational, or speech therapist, sign language, nurse, teacher, etc.):

Emergency Contact Information

Name:

Relationship to Counselor:

Email:

Cell of Emergency Contact:

Home Phone:

Other Phone:

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 a character reference.

Reference 1

Reference 1 Name

Reference 1 Email

Reference 1 Phone

Reference 2

Reference 2 Name

Reference 2 Email

Reference 2 Phone

Reference 3

Reference 3 Name

Reference 3 Email

Reference 3 Phone

Health Insurance Information

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

Carrier:

Policy/Group Number:

Policy Holder Name:

Medications

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.

Are you taking any medication?

Yes

List all medications, dosages, and times medication is to be taken below:

Mandatory Training and Documents.

NOTE: Each applicant MUST complete the required training and background check upon completion of application in order to receive acceptance.

Have you completed the Mandated Reporter Training Course within the last two years from today's application?

YesNo

Criminal Background

Have you ever been charged with or convicted of sexual abuse, assault, battery, neglect or molestation?

YesNo

If yes, please provide a detailed explanation below:

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 that will be in my care. Background checks may include, but are not limited to criminal background checks, driver’s license validation and sex offender listings. Please visit https://true-hire.com/campdream to complete your background check. NOTE: Background check MUST be completed before acceptance occurs.

Initials:

Summer Camp Manual Acknowledgement

Please visit https://www.campdreamga.org/summer-camp-manual to view a copy of the Camp Dream Summer Camp Manual. After you have read it, please read the below and sign your initials at the bottom.

I acknowledge that I have received a copy of the Camp Dream Summer Camp Manual (Manual). I understand that the Manual outlines the operation of the Camp Dream Summer Camp program.

I understand that the working conditions, policies, processes and procedures described in this Manual are confidential and may not be distributed in any way nor discussed with anyone.

I have read and understand the contents of this Manual and will act in accordance with these policies and procedures as a condition of my association with Camp Dream.

I have read and understand the Rules and Standards of Behavior expected by Camp Dream and I agree to act in accordance with the standards of behavior as a condition of my association with Camp Dream.

I understand that if I have questions or concerns at any time about the Manual, I will consult the Summer Camp Director(s), the Program Director, or the Executive Director for clarification.

Finally, I understand that the contents of the Manual are simply policies and guidelines, not a contract or implied contract with Volunteers. The contents of the Manual may change from time-to-time.

By placing my initials below, I acknowledge that I have read, understand and will comply with all conditions contained within the Manual.

Initials:

Liability

I assume the responsibility as a Counselor for Campers assigned to me for the duration of the camping sessions chosen herein above. I, together with my heirs, successors, beneficiaries and assigns (hereafter “Volunteer”), hereby release, absolve, indemnify, and hold harmless Camp Dream Foundation and its affiliates, including without limitation, employees, officers, directors, staff, assigns and volunteers (“Affiliates”). In case of injury or illness to myself, I hereby waive all claims against Camp Dream Foundation and its Affiliates. I acknowledge that all information provided in this application is to be kept confidential.

Volunteer hereby releases and waives any potential future claims against Camp Dream Foundation and its Affiliates for any property damage, illness, death and/or personal injury arising out of or relating to 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.

In addition to any other risks posed by participating or volunteering with Camp Dream Foundation, Volunteer understands that, despite any safety precautions being taken by Camp Dream Foundation, by participating or volunteering, there is a risk of potential exposure to COVID-19 or any other harmful virus or bacteria, which may result in illness or death. Volunteer releases, forever discharges, indemnifies and holds harmless Camp Dream Foundation and its Affiliates from any and all liability, claim, costs or expense related to such risk.

The above liability waiver and release will be governed by the laws of the state of Georgia and in intended to be read as broad as inclusive as permitted by such laws.

Initials:

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.

Initials:

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 or Volunteers during the sessions chosen herein above.

Initials

Affirmation and Consent

I hereby affirm 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.

Initials:

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

Applicant's Signature:

Today's Date:

Contact ID

Account ID

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