Benton Day Camp Adult Volunteer Form 2025

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Name:* This field is required.

First Name

Last Name

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Sex* This field is required.

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Pronouns (optional)

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Birthdate* This field is required.

Date

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Mailing Address* This field is required.

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

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Primary Phone* This field is required.

Please use this format: ###-###-####

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Secondary Phone

Please use this format: ###-###-####

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Email* This field is required.

example@example.com

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For important information, I can receive & send TEXT messages.* This field is required.

YESNO

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List your children who will be attending Benton Day Camp by full name, age and grade in Fall.

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I would like to volunteer as . . .

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Unit "Super" (Support Unit Person & Extra Resource)

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Unit Leader (UL)

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Program Aide (PA) Mentor

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Assistant PAIT (Program Aide-In-Training) Director

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Outdoor Skills Teacher

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Arts & Crafts Teacher or Assistant

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Food & Snack Assistant

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Generalist -- I'll go wherever you need me at camp

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Assistant Transportation Coordinator

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Transportation Check-In and/or Check-Out

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Camp Set-Up

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Camp Take-Down

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Thursday Cookout Coordinator

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Thursday Cookout Helper

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Camp Patch Orderer

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Camp Photographer

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Camp T-Shirt Coordinator

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Water Buffalo Washer

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Hiking Assistant

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Comments and/or questions on previous answers

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For the following amount of time* This field is required.

the full camp day

Morning

Afternoon

Other

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We need adult presence on our buses to meet correct adult-to-camper ratio. There is also very limited parking available at camp. Please plan on riding the bus to and from camp on your volunteer days. Thank you!

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Comments and/or questions on previous answersDay(s) and amount of time I can volunteer

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Any volunteer working directly with children is required to complete the Volunteer Application Process. This includes

Girl Scout membership registration
Disclosure
Current GS Background Check
Health History & OTC Medications Form

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Are you currently a registered Girl Scout?* This field is required.

Yes

No

Unsure

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Are you currently a Girl Scout Leader?

YESNO

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If Yes, what is your Service Unit Number?Benton County is Service Unit 29.

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What is your Troop Number?

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Do you hold a current First Aid / CPR card?

YESNO

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Any volunteer working directly with children is required to complete a Girl Scout Background Check every 3 years. If your Background Check has expired, we will notify you.

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Have you completed the Volunteer Application Process within the last 3 years?* This field is required.

Yes

No

I am not sure

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Women's or Men's Style T-shirtfor those helping more than 1 day either out at camp or with Check-In and/or Check-Out

Women's

Men's

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Optional Hooded Sweatshirt

We have a cool optional sturdy Benton Day Camp hooded sweatshirt with our original logo for campers, staff and all volunteers for $35.00. Stay warm and show your love for our Benton Day Camp all year round!

To order our new camp hoodie, go to the Benton Day Camp Hooded Sweatshirt Order Form.

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Girl Scout camps have a fun tradition whereby counselors and staff have camp names. If you'd like, you may choose a camp name related to a hobby, favorite food, book/movie/TV character, nature, etc. Examples are Rainbow, Cougar, AppleJack, Squirt, Gypsy, Flint, Colorado, Diesel, Peanut, Piglet, Sunset, Lollipop, Skittles, Phoenix...

If you don't know yet, please choose one by July 4 and tell the Camp Director so she may include it on Day Camp schedules, unit rosters, etc.

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My camp name is

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Media Permission & Signature

When participating in Girl Scout activities, I may be photographed for print, videotaped or electronically imaged. Images may be used in promotional materials, news releases and other published formats for either the local Girl Scout Councils or Girl Scouts of the USA. The images will be the sole property of either the local Girl Scout Council or Girl Scouts of the USA.

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Media Permission

I wish to opt out of media permission at this time.

I wish to opt out of GSUSA / GSOSW emails and/or texts at this time

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I accept and abide by the Girl Scout Promise and Law.

By entering my name below, I accept the above conditions and releases.

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Signature* This field is required.

Clear

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Signature* This field is required.Printed Signature

First Name

Last Name

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Today's Date* This field is required.for Electronic Signature

Date

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Other information:

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To fully care for our volunteers, we require a Health History & Over-The-Counter Medications Form for every person who steps foot in camp.

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Will you be volunteering on camp property?i.e., at Rock Creek Campground?

YESNO

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Any volunteer working directly with children is required to complete the Volunteer Application Process. This includes Girl Scout membership registration, disclosure and background check. Day Camp also requires a Health History & OTC Medications Form.

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I will complete the Health History & OTC Medications Form* This field is required.

Online

I don't need to complete a Health History & OTC Meds Form because I will not be on camp property.

I would rather mail it to the Day Camp Health Supervisor

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If you prefer to complete the Health History & OTC Medications Form online, click on the following link: online History & OTC Medications Form - Adult

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If you prefer to USPS mail your Health History & OTC Form, please download and mail ASAP to:

Heather Herman

Benton Day Camp Health Supervisor

2565 Newgate Dr.

Philomath, OR 97370

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Thank you for completing the Benton Day Camp 2025 Adult Volunteer Form.