Camp Friendship 2015 Counselor Application

Camp Friendship 2015 Counselor Application

Camp Friendship is a summer day camp for children with developmental disabilities in the surrounding areas. Camp Friendship is funded through The Arc of Jefferson and Clearfield County and the Run/Walk for Someone Special. We are in need of counselors to help with this year’s camp. The responsibility of a counselor involves the supervision of an assigned camper to ensure safety and quality of their time while at camp. If you are interested we would appreciate any amount of time you have to volunteer. Counselors must be at least 11 years old to attend as a volunteer. Thank you for your interest in Camp Friendship!

*Volunteers 18 or older will need to provide Act 34 and 151 Clearances.
When: June 9^th -12^th, June 15^th-June 19^{th, and} June 27^th (Punxsutawney Fireman’s Parade)

Where: Camp Friendship near Reynoldsville, off Route 322. Any counselor attending may meet a bus at the Punxsutawney Area Community Center parking lot each morning at 8:30 am and the bus will return each afternoon at 2:45pm.

How: Fill out this application and return it to the address listed below by May 22th^. You can also return completed applications to the Punxsutawney Middle School or High School Guidance Office by May 22^rd. If after May 22rd, mail the form.

All applicants are accepted unless otherwise notified.

Name: Betsy Buffington

Address: 600 Rockland Ave., Punxsutawney, PA 15767

Phone: [phone]

Counselor Responsibility Form

As a counselor, I understand I am a volunteer for The Arc of Jefferson and Clearfield County’s Camp Friendship Summer Program. My signature on the bottom of this form certifies I have read and understand my duties as a counselor. If I had questions or concerns I spoke to the director before signing.

1. 
   As a counselor, I understand it is my responsibility to assist the camper I am assigned throughout the entire day.
   
2. 
   As a counselor, I understand it is my responsibility to know where my assigned camper is at all times throughout the day.
   
3. 
   I will treat all campers, counselors, and adults with respect. I understand if I have a problem concerning a camper, counselor, or an adult, I will talk to the director.
   
4. 
   I understand as a counselor, I am there to be a role model. This includes the bus, camp, and community outings.
   
5. 
   I understand as a counselor, the activities at Camp Friendship are designed for the campers, and I am there to assist them with the activities and help ensure they have an enjoyable experience at Camp Friendship.
   

Camp Friendship 2015 Counselor Application
Name: ___________________________ Circle: Male or Female
Address: ________________________ E-mail_________________
Phone Number: ______________Age:___Grade: ____ Shirt Size: ____Adult

Youth
Experience: Have you ever worked with handicapped/intellectually disabled persons? Y N If yes, when and where? __________________________

Counselor Responsibilities: Please sign below to indicate that you fully understand the counselor responsibilities on the previous page and have addressed any questions or concerns if you had any to the camp director prior to signing.

Volunteer Signature: ____________________Date:________________

Interest Statement: Please write a brief paragraph explaining why you want to volunteer as a counselor at Camp Friendship.


Parent Signature: ______________________ Date: _____________

My signature indicates my permission to and support for the above volunteer in his/her interest being a counselor at Camp Friendship.

Medical Concerns: Please list any medical concerns or allergies we should be aware of for this volunteer. ______________________________________________________
Video/Photo Release: I give permission for my child to appear in video footage or photo releases used to promote Camp Friendship.

Parent Signature: ______________________ Date _______________