• Camp Jamie Returning Volunteer Application

    Camp Jamie Returning Volunteer Application

    All information is strictly confidential
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  • Personal Loss History

  • Relationship Year of death Age of diseased     Cause of death      
    Relationship      Year of death      Age of diseased      Cause of death         
    Relationship      Year of death      Age of diseased      Cause of death      
    Relationship      Year of death      Age of diseased      Cause of death      
    Relationship      Year of death      Age of diseased      Cause of death      
    Relationship      Year of death      Age of diseased      Cause of death      

  • VOLUNTEER HEALTH HISTORY FORM

  • I know of no health reasons, other than information indicated on this form, whyI should not participate in any of the Camp Jamie activities.

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  • Authorization for Emergency Medical Treatment

    Should a medical emergency arise during my participation in Camp Jamie activity and I am unable to speak for myself, I consent to:

    1. The administration of medical treatment and/or surgical procedures deemed necessary by the medical doctor and/or medical facility identified below or chosen by the Camp Jamie Director.

    2. The immediate administration of life-sustaining measures deemed necessary under the circumstances.

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  • Volunteer Release of Liability

  • I understand and agree that Frederick Health Hospice, Frederick Health, Board of Directors, Employees and Volunteers are released from any legal responsibility and/or liability for negligence arising out of any accidents or illnesses which occur while the volunteer listed below attends Camp Jamie.

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  • Volunteer Publicity Permission

  • Upon occasion, videotaping and/or photography may occur during camp activities. This material may be used for future publicity by Frederick Health Hospice, Frederick Health and its Board of Directors. In addition, with Hospice staff permission and supervision, the news media maywish to photograph, videotape and/or interview some of the volunteers and children attending camp. Please sign below if you have no objections to being subject to this.

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  • Consent for Background Check

  • Due to the nature of services provided, background checks are required to be completed for all new volunteers, as well as every two years for all returning volunteers. Frederick Health Hospice utilizes HireRight to complete these background checks.

    I agree to have a background check completed, and I understand that I will be receiving an email from HireRight with a link to enter my information and complete a background check, if fall into one of the groups stated above.

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  • Should be Empty: