Volunteer & Instructor Application
Location: Roosevelt Neighborhood Center, Charleston, WV Dates: June 22 - June 27 Camp Hours: Monday–Friday | 8:00 AM – 4:00 PM Final Showcase & Block Party: Saturday (12 PM – 4 PM)
Name
First Name
Last Name
Preferred Pronouns
Date of Birth
-
Month
-
Day
Year
Date
Phone Number
-
Area Code
Phone Number
E-mail
example@example.com
Emergency Contact Full Name
First Name
Last Name
Emergency Contact Email
example@example.com
Emergency Contact Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Briefly describe your experience working with youth:
Why Are You Interested in Being Involved?(Briefly share your motivation or what you hope to contribute)
List any relevant licenses, certifications, or areas of expertise: (e.g., Social Work, CPR, Teaching, Food Safety, Yoga Certification). Keep in mind that you will need to provide these documents/certifications before camp
Position you are applying for:
Volunteer - General Support
Volunteer - Junior Counselor(High School Student)
Teacher/Instructor - Wellness
Social Worker/ Therapist/Counselor - Specialist in Emotional Regulation
Instructor - Art/Music/Dance/Theater - Creative Expression
Instructor - Nutrition/Food Education
Guest Speaker - Career Exploration
Block Party Support - Final Day (Saturday, June 27)
Board of Camp (Obligation: virtually meet once a month, delegate and complete tasks, and be an onsite support for camp week)
Volunteer OnSite Nurse/Doctor
Volunteer Instructor - not listed above pertaining to wellness
Days and you are available
Monday (June, 22)
Tuesday (June, 23)
Wednesday (June, 24)
Thursday (June, 25)
Friday (June 26)
Saturday Showcase (June, 27)
Hours you are available
Morning
Afternoon
Evening
Full Day
Have you ever worked with children before?
Please Select
Yes
No
Are you willing to undergo a background check?
Please Select
Yes
No
Have you ever been convicted of a crime?
Please Select
Yes
No
If yes, please explain:
Tshirt Size
XSmall
Small
Medium
Large
XLarge
2XLarge
3XLarge
Submit a professional reference and a personal reference
Agreement & Signature I understand that submitting this application does not guarantee placement, and all volunteers and instructors are subject to screening. I agree to act in the best interest of children, families, and staff during my time with the Charleston Summer Wellness Camp. (If under 18 have a Parent or Guardian sign)
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