Volunteer Sign-Up Page Volunteer Application Tell us about you* First Last Phone*Date of Birth* Gender*MaleFemaleAddress* Street Address City State ZIP / Postal Code Occupation*Number of Years*Email Address* General QuestionsAre you our friend on Facebook?*YesNoHow did you hear about CampT-Shirt Size*SmallMediumLargeX-LargeXX-LargeXXX-LargeCPR Certification is required for all volunteers attending camp. Do you have certification in the following? Please send a copy of your certification to Medical.Director@campriverrun.org* CPR First Aid Nurse EMT None What area(s) would you like to help in the most?* Activities Camp Counselor Medical Do you have previous training or background in dealing with children with disabilities or life threatening illnesses?*YesNoPlease describe why you wish to work with children with disabilities or life threatening illnesses*Please describe any previous experience working with children*Emergency Contact#1Name* First Last Cell Phone*Email Relationship*Do you or have you ever had a disability or life threatening illness?*YesNoPlease desribe and explain*Do you have any medical conditions/illnesses?*YesNoPlease describe and explain*Please describe any developmental delays and/or behavioral needs*Are you currently taking any medications?*YesNoMedications*MedicationRoute: (oral, injection, etc.)DosageTime GivenPurpose Please list any medications you are currently takingDo you have any allergies?*YesNoAllergies*AllergyReaction Please include food, environmental, and medication allergiesRegarding under age volunteer: Is it okay for CRR Medical Team to give over the counter medications not listed if no allergies are indicated?YesNoe.g. Tylenol, Ibuprofen, Gas X, Imodium, Tums, etc.Dietary RestrictionsIf you do have diet restrictions, please include a small list of food and drinks that you can have and enjoy havingSpecial Assistance/ Needs/ RestrictionsHave you had any serious injuries in the last three years?*YesNoPlease explain*Personal ReferencesPlease include at least one employer referenceName* First Last Phone*Address* Street Address City State ZIP / Postal Code Name* First Last Phone*Address* Street Address City State ZIP / Postal Code Name* First Last Phone*Address* Street Address City State ZIP / Postal Code Background HistoryHave you ever been convicted of any crime including, but not limited to; assault and battery, sexual assault, indecent exposure, rape, kidnapping, distribution/trafficking of narcotics and/or controlled substances, or intent to commit any of these acts.*YesNoHave you ever taken drugs other than prescription drugs?*YesNoIf you answered “yes” to any of the previous questions, please explain*Submit a current pictureAccepted file types: jpg, gif, png, pdf.Please upload a current picture of yourself for referance.Please download and sign the following document. Download You can scan the signature and upload it to the field below, or just bring it to your meeting.NameThis field is for validation purposes and should be left unchanged.