Volunteer Application 2025

Emergency Information
Emergency Contact's Name

First NameLast Name
Relationship
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Alt. Phone Number

Area CodePhone Number
Email
example@example.com

What size t-shirt do you wear?

Do you have any allergies or health conditions that we need to be made aware of?
Please list any relevant Camp, volunteer, child care experience as well as experience with individuals who have Autism.
Special Hobbies or Skills that you would like to share about yourself (and that may be of interest to our campers):

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.
Confidentiality Agreement

As a member of the Camp T.A.L.K. Staff, I understand that confidential interactions and experiences with our campers and their families will occur, as well as review of private records. Any information I obtain from the camp experience or private records is to be considered highly confidential. The use of such information is subject to normal standards of medical confidentiality. No Identifying information about campers is to be revealed in subsequent discussion or writing about the camp experience. General information should not be shared other than for purposes offormal camp evaluation or professional growth. Please siging your name (typing below) and dating, you agree to the terms and conditions above.
Confidentiality Agreement SIgnature:

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Informed Consent and Acknowledgement

As a volunteer of Camp T.A.L.K., I hereby agree to waive any claim for liability against Camp T.A.L.K., TALK Services, or Willow Ridge Church due to any injury/illness associated with any camp activities. The undersigned is aware of potential risks and agrees that this waiver applies while traveling to and from camp, attending the Camp, and participating in any camp programs and events. By signing your name below, you agree to the terms and conditions above.
Signature for Consent to Participate & Waiver:

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Photo Release

Photo / Media Release: I give permission for Camp T.A.L.K. / TALK Services/ WillowRidge Church to use my photograph for promotional, advertising or media purposes. The undersigned hereby waives, releases and forever discharges Camp T.A.L.K. / TALK Services / Willow Ridge Church, its officers,agents, employees or representatives, and all others, from any and allresponsibilities, liabilities, or payment for participation. By signing (typing your name) and dating below, you agree to the terms above.
Signature for Photo Release

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Medical Release and Authorization

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 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 / or immunizations.

Permission is also granted to Camp T.A.L.K. / Talk Services / Willow Ridge Church and its affiliates including Directors, Volunteers, and Small Group Leaders to provide the needed emergency treatment prior to any 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.
Signature for Medical Release

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Reference(s): Please list two non-family related references. Please provide their name, phone number, and relationship to you.
Reference 1: Name

First NameLast Name
Relationship
Phone Number

Area CodePhone Number
Reference 2: Name

First NameLast Name
Relationship
Phone Number

Area CodePhone Number
References

Please provide the name and contact information of 2 non family member references.
Name

First NameLast Name
Email
example@example.com
Phone Number

Area CodePhone Number
How do you know this person?
Name

First NameLast Name
Email
example@example.com
Phone Number

Area CodePhone Number
How do you know this person?
General Information:

Volunteers should arrive at 9:30 for regular camp days. Any change to the schedule will be listed prior to the beginning of camp. Volunteers will not be placed in the same group as family members who are campers. We will have a volunteer orientation, training prior to camp.

Volunteers will be notified by e-mail of their acceptance as a Camp T.A.L.K. Volunteer. Thank you for being willing to serve our kids! :) We are looking forward to an exciting summer.

For the safety of our children, volunteers are subject to a background check.
Should be Empty:

Volunteer Application

References