Information Request Form

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 NameLast Name
Preferred Pronouns
Date of Birth

MonthDayYear
Date
Phone Number

Area CodePhone Number
E-mail
example@example.com
Emergency Contact Full Name

First NameLast 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:
Days and you are available
Hours you are available
Have you ever worked with children before?
Are you willing to undergo a background check?
Have you ever been convicted of a crime?
If yes, please explain:
Tshirt Size
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)
Should be Empty:

Volunteer & Instructor Application