Camp Crescent Moon 2025 Medical Team

Medical Team Application

Camp Dates - July 19-25, 2025
Thank you for being interested in volunteering for Camp Crescent Moon.

Please be prepared to upload the following items with the application.

1. Copy of professional license (if applicable)

2. Copy of Government Issued ID (first-time volunteers)
Name*

First NameLast Name
Email*

Confirmation Emailexample@example.com
Phone Number*
Please enter a valid phone number.
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Profession (check all that apply)*

MD/DONPRNLVNSocial Worker (BSW/MSW/LCSW)PsychologistPAOther
Specialty (select all that apply)*

PediatricsAdultsTeensOther
License # (if applicable)
State licensed (if applicable)
Please upload copy of medical/professional license:

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Profession (check all that apply)*

MD/DONPRNLVNRN Student (limited availability)LVN Student (limited availability)Social Worker (BSW/MSW/LCSW)PsychologistPAOther
Have you volunteered as a Medical Provider at Camp Crescent Moon before?*
FIRST-TIME VOLUNTEERS - Please upload copy of your government issued identification with a photo (Driver's license, ID card, Passport)

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Employer (or school if applicable)*
Department*
Address (Employer or School)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact*

First NameLast Name
Emergency Contact Phone*
Please enter a valid phone number.
Emergency Contact Relationship*
Are you available to volunteer for the entire camp week? Dates are July 19-25, 2025 (this is Saturday to Saturday)*
If no, please select days of availability (shift time is approximately 8:00 am - 8:00 pm)*

Saturday, July 19thSunday, July 20thMonday, July 21stTuesday, July 22ndWednesday, July 23rdThursday, July 24thFriday, July 25thSaturday, July 26th (end of camp - approximately 1:00 pm)Other
Dietary Preference (we may not be able to accommodate vegan only options)*
Comments
Camp Sleeping Accommodations - I will be:*
What is your T-shirt size?*
What is your Hoodie size?*
Depending on funds, hoodies may be provided to volunteers this year
Have you ever been convicted of a criminal offense?*
Have you ever been charged with child abuse or neglect?*
Has your driver's license ever been suspended or revoked?*
Please explain if you answered yes to any of the above questions.
Other than the above questions, is there any fact or circumstance involving you or your background that may call into question your working with children? If yes, please explain:*
Upon submission of this application, you will receive the following documents via email for completion:
1. Applicant Release & Authorization (for background check)
2. Medical History Form
3. Immunization Update (PPD, Tetanus & Hepatitis B)
Thank you for your interest in volunteering at Camp Crescent Moon.

We will follow up with you shortly.
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Medical Team Application