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Family Application
Volunteer
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Guthrie Sibling Day Camp
Special thank you to Logan County Sibshops, Sooner SUCCESS, and the Camp Joy for their collaborative efforts to provide a Sibling Day Camp for families in Logan, Lincoln and Oklahoma County and neighboring areas. The camp will take place on June 9th from 10am-5:30pm followed by an OPTIONAL Family Dinner and Chapel Service!
General Family information
Does your child/young adult have Intellectual/Developmental Disability?//¿Tiene su niño/joven adulto una discapacidad intelectual/del desarrollo?
Yes
No
Has your child attended Sibling Camp in the past?//¿Su hijo ha asistido al campamento para hermanos en el pasado?// *
Yes
No
Does your child/young adult have a sibling attending camp with them?//¿Su hijo/adulto joven tiene un hermano que asistirá al campamento con él?(Definition of a sibling: biological, adopted/foster families, legally responsible guardians under the same household) *
Yes
No
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Day Campers without Disabilities (Siblings) Attending
Name of Sibling without disabilities Attending Sibshops (Sibling without disabilities #1 Info)
*
First Name
Last Name
Age of Sibling (Sibling without disabilities #1 Info)
Shirt Size (Sibling without disabilities #1 Info)
Name of Sibling without disabilities Attending Sibshops (Sibling with disabilities #2 Info)
First Name
Last Name
Age of Sibling (Sibling without disabilities #2 Info)
Shirt Size (Sibling without disabilities #2 Info)
Name of Sibling without disabilities Attending Sibshops (Sibling without disabilities #3 Info)
First Name
Last Name
Age of Sibling (Sibling without disabilities #3 Info)
Shirt Size (Sibling without disabilities #3 Info)
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Day Campers With Disabilities Attending
Name of Sibling with disabilities Attending Sibshops (Sibling with disabilities #1 Info)
*
First Name
Last Name
Diagnosis: (Sibling with disabilities #1 Info)
Age of Sibling (Sibling with disabilities #1 Info)
Shirt Size (Sibling with disabilities #1 Info)
Name of Sibling with disabilities Attending Sibshops (Sibling with disabilities #2 Info)
First Name
Last Name
Diagnosis: (Sibling with disabilities #2 Info)
Age of Sibling (Sibling with disabilities #2 Info)
Shirt Size (Sibling with disabilities #2 Info)
Name of Sibling with disabilities Attending Sibshops (Sibling with disabilities #3 Info)
First Name
Last Name
Diagnosis: (Sibling with disabilities #3 Info)
Age of Sibling (Sibling with disabilities #3 Info)
Shirt Size (Sibling with disabilities #3 Info)
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Emergency Contact Information
Name of Individual Enrolling Child (Caregiver/Parent)
*
First Name
Last Name
Relationship to Child
*
Telephone
*
Please enter a valid phone number.
Email
example@example.com
Emergency Contact #1
*
First Name
Last Name
Phone Number #1
*
Please enter a valid phone number.
Emergency Contact #2
*
First Name
Last Name
Phone Number #2
*
Please enter a valid phone number.
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Siblings with and without disabilities Allergies and Behavioral concerns
Do any of the Day campers attending have any allergies we should be aware of?
Please explain any 1. concerning behaviors 2. Triggers and 3. Ways that you address the behavior at home along with the name of the camper.
What do you hope your child will gain from participating in Sibshops?
Please share about the sibling's relationship with their sibling with disabilities?
I assume all risks and hazards of the conduct of the program and release from responsibility any person providing transportation to and from activities. In case of injury, I do hereby waive all claims or legal actions, financial, or otherwise against, Sooner SUCCESS, their elected officials and employees, the organizers, sponsors, supervisors or any volunteer connected with the program. In absence of a signature, payment of fees and participation in the program shall constitute acceptance of the conditions set forth in release. I grant full permission to use any photographs, videotapes, motion pictures, recordings, or any other record of this program for any purpose. I giver permission for Sooner SUCCESS to release the name, birth date, and diagnosis of the child with special needs as part of the documentation for program funding.
Yes, I agree
No, I don't agree
Signature
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Volunteers
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Do you have previous experience as a volunteer?
Please list previous experience:
Are you first aid/CPR certified?
Yes
No
Are you a trained medical professional?
Yes
No
Are you comfortable assisting an individual with incontinence issues (bathroom support)?
Yes
No
Have you ever been convicted of a felony?
Yes
No
Would you be willing to complete a background check?
Yes
No
Do you have a recent background check?
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Vendor
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Please describe organization services:
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