Please attach a current picture to this application
Applicants between the ages of 16 and 18 desiring to be a counselor, must complete this application and their parent or guardian must request that they be assigned as a counselor.

Junior Counselor Personal and Health Information


Junior Counselor:

Parent or Guardian (1)
Telephone:
Parent or Guardian (2)

Emergency Contact: (Must be other than parents and guardians listed above)

Emergency Contact
Certifications






Personal References:
Provide three personal references over the age of 18 that can vouch for your work ethic and character.









Health Insurance:

Coverage for illnesses or injury while participating in programs at Camp Dream is the responsibility of the Junior Counselor’s parents or legal guardians. 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.
Do you have:








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.
Medication
List all medications, dosages, and times medication is to be taken. Medications will be administered exactly as written below. Please be accurate and complete. You must provide all medications for your child. All medication must arrive in original container with the prescription label intact and legible. If no medications are taken, please write “none” for the name of the medication. 






























Tell Us About You

The remaining questions in this section are optional but help us to get to know you better.
Describe any experiences you have had that have prepared you to be a junior counselor and work with special needs kids.

ATTENTION: Junior Counselors, Parents/Guardians, and all pertinent parties.

First and foremost, the Camp Dream Foundation would like to express how extremely grateful it is for every participant who chooses to help us in furthering our mission to improve the quality of life for children and young adults with special needs through operation of Summer Camp and Camp Out programs, and other recreational and educational activities. Moreover, we would like to ensure you that we do everything within our power to provide a safe environment for you while volunteering.

You will be provided a room in one of our cabins which you are expected to stay in. Your room assignment cannot be changed by anyone other than our Camp Director Alicia Bryson. If you have concerns with your room assignment, please see Alicia immediately.

Junior Counselors will not be responsible for campers. However, you may be assigned to help a Counselor with a camper but will not be responsible for the camper at any time. Please be advised that should you have any issues while at camp we will do our best to resolve them as quickly as possible. In order for your concerns to be addressed you must report them to the Camp Director Alicia Bryson immediately.

Liability


I am assuming the responsibility as a Junior Counselor for the duration of the camping session(s). 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.  

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. 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 

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 session(s) I am signed up for.

Want to be a Counselor instead of a Junior Counselor?

Junior Counselors are vital to the running of our camping session. However, we understand that some of you would like to take on more responsibility. You must be at least 16 in order to be a Counselor. If you wish to be a Counselor, please be aware that this includes you being responsible for a Camper for the entire session. You may be required to bathe, feed, change clothes and make sure medications are taken (with the help of the medical staff). The Camp Director Alicia Bryson is the only staff member that can or will assign you a Camper. Not everyone that wants to be a Counselor may be selected for that position. You will be advised upon arrival if you have been placed in the Counselor role.

PARENTS/GUARDIANS/PARTICIPANTS: Volunteering to be a Counselor is an immense responsibility and therefore is not something that should be entered into lightly. However, on balance, with greater responsibility comes a much more edifying experience. If you are confident of your child's ability to accept such a responsibility please acknowledge so with your initials/signature below.

Counselor Liability
I am assuming the responsibility as Counselor for a Camper assigned to me for the duration of the camping session. 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.

Counselor Affirmation and Consent
I hereby acknowledge and provide my permission for the Applicant to be a Counselor. I understand that he/she will be subject to see or hear things that he/she may not be subject to in his/her everyday life as aforementioned herein (Diminished Capacity).

Application Affirmation and Consent

I hereby affirm that all information given is true and complete. By signing below, I warrant that all information entered with this application is complete and accurate. I also warrant that I have legal authority to grant the rights granted above. I understand and agree that if I have misled Camp Dream Foundation, my application and/or staff position will be terminated immediately.