Camp Jamie NEW Volunteer Application

Personal Loss History

This information helps staff pair up Little Buddies and Big Buddies.
Loss History:
Relationship: Year of death:       Cause of death:

Relationship:    Year of death:      Cause of death:

Relationship:      Year of death:      Cause of death:

Relationship:      Year of death:        Cause of death:

Relationship:      Year of death:         Cause of death:

Relationship:      Year of death:         Cause of death:

Camp Logistics
Specifically for Camp Jamie overnight camp, there are assigned volunteer roles: Big Buddy and Support Staff.

Big Buddy*

You are paired with a camper (called a Little Buddy) of the same gender. You will spend the weekend with your Little Buddy providing companionship, support, friendship, and individualized attention. We do our best to pair little and big buddies that we think are the best possible fit for each other.

Support Staff*

You help the grief counselors and vendors set up and cleanup activities and crafts. You will provide any help or support to a Big Buddy, and act as an escort to Big Buddies and Little Buddies in certain situations. You will interact with campers but will not be assigned a specific camper like the Big Buddies.

*All Volunteers (Big Buddies and Support Staff) will be expected to sleep in the cabins with the campers on bunk beds and must be able to stay the entire weekend.
What position would you like to hold at Camp Jamie? (Check All That Apply)

Big BuddySupport Staff
I acknowledge Camp Jamie campers have experienced a wide range of losses including suicide, overdose, homicide, accidents, illnesses, and other traumatic events.*

Yes, I understand and agree that if any of these losses make me uncomfortable I will talk to the camp staff for support.No, I don't understand and would like more information.

Emergency Contact Information & Personal Health
Person to notify in case of emergency: blanks* .
Relationship to you:blank*.
Cell phone*
Other phone
Please list any allergies you have.*
Please list any dietary restrictions you have.*
Please list any medical problems or health diagnoses that you feel would be relevant for us to be aware of that could affect your ability to be outside for a prolonged period of time, to be physically active, to keep up with a camper, to handle potential emergencies, and/or to support campers.*
Do you have any physical limitations?*

YesNo
If yes, please explain.*
All medications must be kept with the camp nurse for the safety of all campers and volunteers (unless the medication is on your person for the entirety of camp). Are you planning to bring any medication with you to camp?*

YesNo
By signing below (please read/check all):*

I acknowledge that I know of no health reasons, other than information indicated on this form, why I should not participate in any of the Camp Jamie activities.I agree that should a medical emergency arise during my participation in Camp Jamie activity and I am unable to speak for myself, I consent to Camp Jamie staff calling 911 and notifying my emergency contact identified in this application.I confirm that the information provided in this application is true and accurate.
Signature*

Clear
Print Name*
Date*

MonthDayYear
Date

CAMP JAMIE VOLUNTEER APPLICATION

VOLUNTEER RELEASE OF LIABILITY
I understand and agree that Frederick Health Hospice, Board of Directors, Employees and Volunteers are released from any legal responsibility and/or liability for negligence arising out of any accidents or illnesses which occur while the volunteer listed below attends Camp Jamie.
Signature of Volunteer*

Clear
Date*

MonthDayYear
Date
VOLUNTEER PUBLICITY PERMISSION
Upon occasion, videotaping and/or photography may occur during camp activities. This material may be used for future publicity by Frederick Health Hospice and its Board of Directors. In addition, with Hospice staff permission and supervision, the news media may obtain permission to photograph, videotape and/or interview some of the volunteers and children attending camp. Please sign below if you consent to participating in publicity for Camp Jamie.
Signature of Volunteer*

Clear
Date*

MonthDayYear
Date
BACKGROUND CHECK CONSENT
I understand and consent that Frederick Health Hospice will conduct a background check through HireRight as a part of my application to be a Camp Jamie volunteer.
Signature of Volunteer*

Clear
Date*

MonthDayYear
Date
Upload an Updated Photo of yourself to go with your Volunteer Application! *

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Work & Relevant Experience with Kids/Teens