Fillable 2021 Camp Volunteer Application (Girl Scouts of Eastern Missouri)

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2021 Camp Volunteer Application (Girl Scouts of Eastern Missouri)

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Applying for: c Family Camp c Day Camp c Day Camp Aide
c Other Activities
CONTACT INFORMATION:
Legal Name:
————————————————————————————
First Last
Address:
—————————————————————————————
Street
———————————————————————————————————
City State Zip
Day Phone:
————————————————————————————
Evening Phone:
——————————————————————————
Email:
———————————————————————————————
Cell Phone:
————————————————————————————
Currently registered Girl Scout? c Yes c No
Currently registered Girl Scout adult member? c
Yes c No
AIDES ONLY:
Birthdate: ______ / ______ / ______
Basic Camp Aide Course completed? c Yes c No Year _____
Grade 2021-2022 school year
———————————————
DAY CAMP:
Name of camp:
——————————————————————
If you would like to volunteer for more than one Day Camp, list
additional camp names here
———————————————
——————————————————————————————
——————————————————————————————
Names & birthdate of sons, daughters & preschoolers you will
bring to Day Camp:
————————————————————
——————————————————————————————
——————————————————————————————
Have you worked at Day Camp before? c Yes c No
Positions held:
——————————————————————
Time available to volunteer during camp:
c Full-time c Part-time
c Su c M c T c W c Th c F c S
What age level are you interested in working with at Day Camp?
Rank choices 1, 2, 3, etc.
c Daisy c Seniors and Ambassadors
c Brownie c Boys
c Junior c Toddlers
c Cadette c Wherever needed
OTHER CAMPS :
Family Camp Other Camps
c Camp Cedarledge c Cadette Camp-A-Rama
c Camp Tuckaho
c Climbing Wall/Zipline
c
Camp Fiddlecreek c Pack the Creek
c Troop Camp Blitz
c I HAVE NEVER BEEN A REGISTERED ADULT IN THE
GIRL SCOUTS OF EASTERN MISSOURI. (ALL VOLUNTEERS
MUST BECOME REGISTERED GSUSA MEMBERS AND COMPLETE
THE VOLUNTEER APPLICATION PROCESS, INCLUDING A GSEM
BACKGROUND CHECK. COPIES OF THESE MATERIALS WILL
BE FORWARDED TO YOU AFTER WE RECEIVE YOUR STAFF
APPLICATION.)
c I AM CURRENTLY A REGISTERED GIRL SCOUT FOR THE 2020-
2021 MEMBERSHIP YEAR.
RETURN TO: Girl Scout Service Center, Camp Department, 2300 Ball Drive, St. Louis, MO 63146 or
kkahn@girlscoutsem.org
FOR OFFICE USE ONLY
c GSUSA c GSEM
2021 Camp Volunteer Application
The health and well-being of our girls, volunteers and staff is
our top concern. Our camp guidelines are based on the most
recent guidance from the Center for Disease Control (CDC)
and American Camp Association (ACA) as well as state and
local authorities.
We will continue to inform Girl Scout families of our latest plans
through email and our website, girlscoutsem.org/covid19.
Though camp may look a little different this spring and
summer, we are committed to providing our Girl Scouts an
exceptional and safe outdoor experience.
CERTIFICATIONS:
Certification Exp. Date
c RN
State of License:
c Paramedic / EMT
State of License:
c First Aid
c CPR/AED
_____adult _____child
c Licensed Troop Camper
c Outdoor Adventure Course Instructor
c Archery
c Lifeguard
c Small Craft Safety
INTERESTS & EXPERIENCE:
Which of the following skills would you be willing to share with girls?
Please check the list below or add to this list. Indicate “I” for interest
or “E” for experience in the categories below:
REFERENCES – For Day and Resident Camp:
Two references (not related to applicant) must be listed. Include
name, phone and mailing address of all references.
1. Name:
First Last
Address:
Street
City State ZIP
Day Phone:
Evening Phone:
Email Address:
2. Name:
First Last
Address:
Street
City State ZIP
Day Phone:
Evening Phone:
Email Address:
RACIAL/ETHNIC BACKGROUND:
The following information is requested only to measure progress
toward serving all girls and adults in our jurisdiction.
Please circle one: American Indian/Alaskan Native c
Hawaiian/Pacific Islander c
Asian c
Black/African American c White c Other c
Are you also of Spanish/Hispanic origin? c Yes c No
DISABILITY INFORMATION:
Girl Scouts of Eastern Missouri welcomes the participation of all
girls and adults, and will make reasonable accommodations for
person with disabilities. If in need of an accommodation, please
briey describe below. To further discuss an accommodation,
please contact the Answer Center, 314.400.4600 or email
answercenter@girlscoutsem.org.
Do you or your child need a reasonable accommodation?
c Yes c No
I agree to complete required training and understand there is NO
assurance that I will be placed in the same unit as my child.
Applicant’s Signature
Custodial Parent / Legal Guardian’s Signature if applicant is a minor
RETURN TO: Girl Scout Service Center, Camp Department, 2300 Ball Drive, St. Louis, MO 63146 or kkahn@girlscoutsem.org
2021 Camp Volunteer Application
c Archery
c Bicycling
c Canoeing
c Cheerleading
c Dance
c Games
c Guest Speaker
c Hiking
c Knots
c Nature Crafts
c Orienteering
c Outdoor Cooking
c Sailing
c Sign Language
c Songs
c Other
____
____
____
____
____
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2021 Camp Volunteer Application (Girl Scouts of Eastern Missouri)

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Completed 9 May 2021

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