Volunteer Application Form

Camp HLC

Volunteer Application Form
Thank you for your interest in volunteering with Hope Loves Company at our premier program, Camp HLC!

As a volunteer or chaperone, you will have a very important role throughout the Camp HLC weekend. We are looking for volunteers who are nurturing, responsible, creative, and who can work effectively as part of our Camp HLC team. Camp HLC depends on volunteers to create a fun, safe, and successful weekend. As an attendee, our campers will look to you for encouragement, support, assistance, and guidance.

Please know that our campers and their families are our first priority. We want them to have the best experience possible. You will be camping, working, and making a difference in the lives of some very special people. It's likely that you will get more out of this experience than you will give! Whether you are volunteering your time and skills, or attending camp with a child, you are in for a special weekend.

All camp volunteers will be required to attend a virtual training session prior to the camp weekend and all volunteers are required to complete a background check.

Please email Linda Sermons or call us at 609-570-4547 if you have any questions or would like to learn more about the Camp HLC volunteer experience!

Thank you so much!
Name*

First NameLast Name
Name

PrefixFirst NameLast Name
Birth Date*

MonthDayYear
Email*
example@example.com
Phone Number*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
My gender is:*
We use this information to help us assign camp bunks/lodging as well as group assignments for youth leaders. If you have questions, please let us know.
Pronouns*
Race*

AsianBlack of African AmericanIndigenous Mexican or Central AmericanMiddle Eastern, North African, Near EasternNative American, Alaska Native or First NationsNative Hawaiian and Other Pacific IslanderIndigenous South AmericanWhitePrefer not to sayOther
T-Shirt Size*
Dietary Restrictions/Allergies *
Camp HLC
Have you volunteered at Camp HLC before?*

YesNo
Do you have any special skills/talents or certifications?*

Art TherapistMusic TherapistDoctor/Nurse/EMTDanceGrief Counselor (licensed)Licensed Mental Health ProfessionalTeacherYoga InstructorPhotographySocial MediaCulinary ArtsOther
Do you have any preferences about your volunteer role at camp? Check all that apply and know that we will do our best to accommodate but we may not always be able to based on the needs of our campers and their families.*

Support Age Group 6-9Support Age Group 10-12Support Age Group 13-21Cabin Leader (responsible for all cabin members throughout the weekend)Big Buddy (1/1 buddy for children under age 12 attending without chaperone)Junior Counselor (campers between ages of 15-21 who may be returning campers)Camp PhotographerI'm up for anything!
If you're a member of Phi Delta Theta, please tell us which chapter and University.
Have you been referred by an ALS organization? If so, please share which one.
Educational Background
College/School
Department/Field
Occupation
Company
Department/Position
Is there anything else we should know?
Waiver & Release
1. I plan to participate in any programs, events, and/or camp activities (“Activities”) at CAMP HLC (the “Host”) by Hope Loves Company®, Inc. In consideration of being allowed to use the facilities and participate in any of the Activities, I, the Participant, do hereby:

2. Represent I am physically able and mentally prepared to participate in all Activities. Release waive, discharge, hold harmless and indemnify Hope Loves Company, Inc., their directors, officers, employees, and volunteers (collectively “Releases”) from any and all known or unknown, foreseen or unforeseen, bodily or personal injuries, death and permanent injury, illnesses, damage to property, or other losses, and any consequences thereof, including expenses, costs, and attorney's fees, arising out of or in any way associated with my participation in the given Activities, or travel incidents, to the fullest extent permitted by law.

3. Assume full responsibility for, and risk of, bodily injury, death or property damage due to the negligence of Releasees or otherwise.

4. Authorize Hope Loves Company, Inc. staff, representatives, contractors, or other medical personnel to obtain or provide medical care for me or my child, to transport me or my child to a medical facility and to provide treatment (including hospitalization, medications, anesthesia, surgery) they consider necessary for my or my child’s health. I agree to release (to or by the Host) of any records necessary for treatment, referral, billing or insurance purposes. I agree to pay all costs associated with any medical care and/or transportation, including medical and/or airlift evacuation and related expenses.

5. Understand that I am solely responsible for my transportation to and from CAMP HLC.

6. Understand that I am not to leave the campgrounds for any reason and if I do, will not be permitted to return to our program.

7. Understand that I will need to sign our Sexual Abuse and Confidentiality policy on this form.
Understand that I will follow the camp rules for the health and welfare of all campers.

The Undersigned has read and voluntarily signs this form, and further agrees that no oral representations, statements, or inducement apart from the foregoing written agreement have been made.
I agree to the waiver/release*
Confidentiality Policy
Confidentiality Policy Staff - Paid & Volunteer

Respecting the privacy of our clients, former clients, staff, donors, members, volunteers and of Hope Loves Company, Inc. itself is a basic value of Hope Loves Company, Inc. Personal and financial information is confidential and should not be disclosed or discussed with anyone without permission or authorization from Hope Loves Company, Inc. Care shall also be taken to ensure that unauthorized individuals do not overhear any discussion of confidential information and that documents containing confidential information are not left in the open or inadvertently shared.

Employees and volunteers of Hope Loves Company, Inc. may be exposed to information which is confidential and/or privileged and proprietary in nature. It is the policy of Hope Loves Company, Inc. that such information must be kept confidential both during and after employment or volunteer service. Staff and volunteers are expected to return materials containing privileged or confidential information at the time of separation from employment or expiration of service.

All information concerning our clients, former clients, staff, donors, members, volunteers, financial data, and business records of Hope Loves Company, Inc. is confidential. “Confidential” means that you are free to talk about Hope Loves Company, Inc. and about the programs and your position, but you are not permitted to disclose client names or talk about them in ways that will make their identity known. No information may be released without appropriate authorization. This is a basic component of client care and business ethics. The Board of Directors of Hope Loves Company, Inc., staff and our clients rely on paid and volunteer staff to conform to this rule of confidentiality.
I agree to the confidentiality policy.*
Photo & Video Release
I hereby irrevocably grant to Hope Loves Company®, Inc., its subsidiaries, affiliates, licensees, successors and assigns the perpetual, worldwide right to use, publish, and reproduce, for all purposes my name, image, likeness, voice, and/or quotations in any and all media, languages, formats and markets now known or hereafter devised.

I hereby release Hope Loves Company, Inc., its contractors, its employees and any third parties involved in the creation of Hope Loves Company, Inc.’s publications, from liability for any claims by me or any third party in connection with my participation or the participation of the minor child listed below. Further, I attest that I am the parent or legal guardian of the child listed above and that I have full authority to consent and authorize to execute this Release.

I further grant Hope Loves Company, Inc. all right, title, and interest that I may have in all finished pictures, negatives, reproductions, and copies of the original works, and further grant the right to give, sell, transfer, and exhibit the works in copies or facsimiles thereof, for promotional, commercial or other purposes, as it relates to the mission of Hope Loves Company.

I hereby waive the right to receive any payment for signing this release and waive the right to receive payment for Hope Loves Company, Inc.’s use of any of the material described above for any of the purposes authorized by this release. I also waive any right to inspect or approve finished photographs, audio, video, multimedia, or advertising recordings and copy or printed matter or computer generated scanned image and other electronic media that may be used in conjunction therewith or to approve the eventual use that it might be applied. Further, I hereby release Hope Loves Company, Inc. from all claims of every kind on account of such use.
I agree to the photo/video release*
Sexual Abuse Policy

Hope Loves Company, Inc. has zero tolerance for sexual abuse at the Hope Loves Company, Inc. workplace, at Camp HLC, or at any Hope Loves Company, Inc. event. Hope Loves Company, Inc. has procedures for staff, volunteers, family members, victims of sexual abuse, and others to report sexual abuse. Sexual abuse includes any sexual activity with a child where consent is not or cannot be given.Policies and Procedures:Some, but not all of the physical and behavioral evidence or signs that someone is being sexually abused include:Difficulty in walking;Torn, stained or bloody clothing;Pain;Bruises or bleeding in the genitalia;Reluctance to be left alone with a particular person;Wearing lots of clothing;Fear of touch Some, but not all examples of unacceptable behaviors (i.e. high-risk behaviors) include:Unwarranted, unwanted and/or inappropriate touching of a child;Bullying or harassment of a child;Inappropriate contact or relationships between employees/volunteers and children within the organization Responding appropriately to Child Abuse:Stay calm so as not to scare the child.Comment on and ask non-leading questions about suspicious injuries.Let the child know they did the right thing by telling and that they are not to blame.Avoid making promises you can’t keep such as you’ll never have to speak about it again.Report suspected child abuse immediately using procedures provided.Designated Person:Every person is responsible for ensuring the safety of the children but the executive director (or their designee) is specifically responsibility for implementing this policy and serving as the contact person. Everyone at Hope Loves Company Inc. needs to know who the designated contact person is and how to reach them.Reporting Procedures:Volunteers/staff are required to report suspected child abuse to the executive director (or their designee) immediately, understanding that retaliation is prohibited against the person who makes the good faith report of sexual abuse.The Executive Director (or designee) will immediately report suspected child abuse to the State reporting agency/Police and have all information from the child’s application form available, as needed. If possible, the Executive Director (or designee) as well as the volunteer/staff reporting the abuse will file a report together.The volunteer’s reporting obligation is not fulfilled until they confirm that a report is made.It is important that the report be made as early as possible. At Camp HLC, the designated Contact Person is the Program Manager of Hope Loves Company, Linda Sermons. Linda’s cell phone number is (609) 570-4547.
I agree to the sexual abuse policy.*
Date

MonthDayYear
Date
Signature

Powered by Jotform SignClear
Should be Empty:

Camp HLC

Camp HLC

Educational Background

Occupation

Waiver & Release

Confidentiality Policy

Photo & Video Release

Sexual Abuse Policy