Adult Volunteer Registration for ASP

Who?

Adults who want to give back to their community by sharing their time, talents, and interests with middle school youth.

What Clubs can you volunteer with? & When?

Each club meets on different days; the schedules are listed below:

The Garden Club meets once a week on Tuesdays from 3:45 to 5:45pm. This club promotes a healthy diet, self-empowerment, STEM education, environmental care, and a lifetime of learning and fun. It will be available for any student who would like to learn more about gardening and get a hands on experience in the soil.

The Art Club will run once a month on Mondays from 3:45 to 5:45pm. This club promotes creative problem solving skills, critical thinking skills, creative expression, artistic risk taking, and innovation. It will be available for any student who would like a fun space to let their artsy side run wild.

The Music Club will also run once a month on Mondays from 3:45 to 5:45. This club promotes imagination, intellectual curiosity, a healthy way to deal with stress and anxiety, a sense of achievement, and self-confidence. It will be available for any student who wants an opportunity to learn how to tap into and broaden their musical abilities.

The Mindfulness Club will run twice a month on Mondays from 3:45 to 5:45. This club promotes effective ways to cope with stress and emotions, an open mind to new knowledge, a healthy lifestyle, and a further development of self reflective and social skills. It will be available for any student who wants to learn mindfulness techniques and discover the impact mind and body have upon the way we live our lives.

The Clubhouse will be the new name coined for our current after school service that is available Mondays-Thursdays for students that need a safe place to hangout and/or work on homework until their parents are able to pick them up. This group will continue to meet & operate the same as in the Fall 2020 semester and years prior.

The Archery Club will meet twice a week on Wednesdays and Thursdays in April. This club promotes skills such as focus, goal setting, and improving hand-eye coordination. No prior experience required. This is a great excuse to get outdoors and learn a unique skill.

Where?

Marble Falls Middle School

Questions?
Contact our After School Program Coordinator!
Kayley Lowe
afterschool@campofthehills.org
(737) 251-3056

Volunteer Information

Name

First Name Last Name

Birth Date

Month Day Year

Gender

Male Female

Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Which clubs are you interested in helping with?

The Club House The Garden Club The Mindfulness Club The Art Club The Music Club The Archery Club

Do you have experience working with youth? If so, provide examples.

Photo Release: Can photo/video from the day of the event be used by Camp of the Hills for promotional purposes?

Yes No

Do you need these hours for a specific organization?

Yes No

If so, which organization?

How many hours?

Please list the leader / adviser /sponsor of the volunteer's organization for reference.

First Name Last Name

What is their role / title within the organization?

Email

example@example.com

Phone Number

Area Code Phone Number

Demographic Data

This information will not negatively affect your acceptance or ability to participate in any of our progams. It is solely used to collect data for fundraising / grant writing purposes and to make appropriate accomodations for physical or educational needs.

What languages do you speak? (choose all that apply)

English Spanish

What additional support might you need from the After School Program Staff?

What ethnicities or mix of ethnicities do you have in your family heritage? (please mark all that apply)

Black / African heritage White / European heritage Latino / Hispanic heritage Middle Eastern heritage Native American heritage Asian heritage

Do you have any allergies, chronic illness, or medical conditions? If yes, please describe.

Are you prescribed an inhaler? If yes, please explain any instructions.

Emergency Contact

This is the primary emergency contact that we will use.

Name

First Name Last Name

Relation to Volunteer

Phone Number

Area Code Phone Number

Alt. Phone Number

Area Code Phone Number

E-mail

Additional Contact Information

In case of emergency, we will FIRST contact the emergency contact listed above. If that person does not respond we will then contact the person listed below.

2nd Emergency Contact's Name

First Name Last Name

Relationship

Phone Number

Area Code Phone Number

Alt. Phone Number

Area Code Phone Number

Informed Consent and Acknowledgement

I hereby give my approval for my participation in any and all activities prepared by Camp of the Hills during the After School Programs. In exchange for the acceptance of said candidacy by Camp of the Hills, I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Camp of the Hills and all its respective officers, agents, and representatives from any and all liability for injuries to said volunteer arising out of traveling to, participating in, or returning from selected After School Program activities.

In case of injury, I hereby waive all claims against Camp of the Hills, including all staff, counselors, volunteers, and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all group / youth activities. Some of these injuries include, but are not limited to, the risk of fractures, paralysis, or death.

Medical Release and Authorization

As the named volunteer, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the volunteer's life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed.

Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named volunteer. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact my emergency contact/next of kin listed above in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach them.

Permission is also granted to Camp of the Hills and its affiliates including Directors, Staff, Counselors, Guides, and Activity Volunteers to provide the needed emergency treatment prior to the volunteer's admission to the medical facility.

Release authorized on the dates and/or duration of the registered season.

This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb.

Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

Signature

Clear

After School Program Clubs- Volunteer Registration Forms 2021

Recording Service Hours