ANYTOWN® Volunteer Camp Counselor Application
We require that our ANYTOWN® Volunteers attend the program as a Delegate prior to serving in a Volunteer Camp Counselor position, only IF you are still in high school or under the age of 18. If you are under the age of 18 and have NOT attended the program as a Delegate, please exit this application and complete the Delegate Registration.
*Parent/Guardian MUST assist in the completion of this application IF you are under the age of 18 years old.*
Your Name
*
First Name
Last Name
Volunteer's Contact Information:
Preferred Name (If Different From Above)
Phone Number
*
Format: (000) 000-0000.
Personal Email Address
*
example@example.com
Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Background Screening Release:
All ANYTOWN® staff and volunteers must complete and pass a Level II Background Screening. Community Tampa Bay covers these costs.
I, the volunteer applicant, hereby certify that the information provided relative to the background screening process and on the volunteer application is true and accurate and subject to verification by Community Tampa Bay INC. I authorize the schools, persons, previous employers, agencies and other organizations named in the volunteer application and screening forms to provide Community Tampa Bay INC. (its authorized employees, agents, or representatives) with any relevant information that may be required to arrive at a volunteer decision and hereby release any such schools, persons, employers, agencies and organization from any and all liability, which they might otherwise incur as a result. I understand that any misrepresentation or omission of facts on these forms may be justification for refusal of, or dismissal from, volunteer services. I will comply with all rules and regulations as set forth in Community Tampa Bay INC.'s volunteer policy manual or other communications distributed to volunteers. I understand that I must complete the volunteer application and volunteer training prior to performing volunteer services for Community Tampa Bay INC.
*
I have read the above statement and accept the same as condition of my volunteer services with Community Tampa Bay INC.
Volunteer Applicant's Social Security Number
*
123 45 6789
AGE REQUIREMENT:
You must be 16 years or older to serve in the Volunteer Camp Counselor role at ANYTOWN®.
Volunteer's Birth Date
*
Please select a month
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Please select a year
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Year
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Volunteer's Demographic Information:
This information is used to ensure we are creating cross-cultural interactions and diverse spaces while at ANYTOWN®.
Gender Identity
*
Please Select
Female
Male
Transgender Female
Transgender Male
Nonbinary
Other
Prefer Not to Answer
Preferred Pronouns
*
She/Her/Hers
Race & Ethnicity
*
Asian
Black/African American
Hispanic/Latin(o/a/x)
Middle Eastern
Native American/First Nations/Indigenous
Pacific Islander
White/European American
Other
Please Specify Origin/Tribe/Ethnicity:
Example: Black/African American - Haitian
Language(s) Spoken at Home
*
Example: English & Spanish
Faith/Religious Affiliation
*
Agnostic
Atheist
Buddhist
Christian
Hindi
Jewish
Muslim
Spiritual
Prefer Not to Answer
Other
Does the volunteer identify as someone with a disability?
*
Yes
No
I'm not sure
Please specify and explain your answer. Do you need any accommodations to attend and volunteer at ANYTOWN®? Is the disability a visible or invisible one? This will NOT affect your acceptance as a volunteer at ANYTOWN®; we want to ensure the best experience for all.
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School/Workplace Information
Please complete the following questions about the volunteer's current or past schooling or place of work.
School Name
*
Example: Sumner High School
Year in School
*
Please Select
I will be going into 10th grade
I will be going into 11th grade
I will be going into 12th grade
I have graduated high school
Not Applicable
Name of Current Workplace/Company/Organization
Example: Chipotle
ANYTOWN® Questions
Please have the Volunteer Camp Counselor applicant (NOT the parent or guardian) complete the following questions regarding their past experience with CTB and/or ANYTOWN® and interest in volunteering.
Have you volunteered at ANYTOWN® before?
*
Yes, I have volunteered at the residential ANYTOWN® program.
No, I have NOT volunteered at the residential ANYTOWN® program.
Which year(s) did you volunteer at the residential ANYTOWN® program?
Example: 2024 & 2025
Did you attend ANYTOWN® as a Delegate (Camp Participant)?
*
Yes
No
Why have you NOT attended ANYTOWN® as a Delegate?
*
I do not meet the age requirements to attend as a Delegate (I have graduated high school and am over the age of 18).
I do meet the age requirements as a current high school student. I acknowledge that I must be a Delegate prior to serving as a Volunteer Camp Counselor. I will exit this application and complete the 2026 Delegate Registration.
How did you first hear about Community Tampa Bay/ANYTOWN®? Please list who/what organization or program referred you to us.
*
What impact are you hoping to have as a Volunteer Camp Counselor?
*
What leadership skills are you looking to grow within this role?
*
Any particular talents, skills, or interests you'd like us to know about you?
Example: I can juggle!
Do you hold any additional licensing or certifications? If so, please list:
Example: CPR, Mental Health First Aid, First Aid, etc.
Select T-shirt size
*
Extra Small
Small
Medium
Large
Extra-large
2X
3XX
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Availability/Residential Questions
Prior to submitting this application, please ensure you are available for the 2026 ANYTOWN® dates: Sunday, June 7th-Friday, June 12th. If selected to be a residential volunteer, you are committing to ALL 6 days and 5 nights.
I confirm that I am available Sunday, June 7th through Friday, June 12th 2026.
*
Yes!
No.
Dorm Preferences
*Gender Expansive Dorms house ANYTOWN® Delegates, Volunteer Camp Counselors, and staff who identify within and outside of the gender binary.
If selected to be a Volunteer Camp Counselor, what is your dormitory preference?
*
Boys Only Dorm
Gender Expansive Only Dorm
Girls Only Dorm
Boys OR Gender Expansive Dorm
Girls OR Gender Expansive Dorm
Dormitory Participation Consent:
ANYTOWN® is a residential program. Community Tampa Bay INC. and the ANYTOWN® program’s vision for a community free from all forms of discrimination is showcased through many different aspects of the ANYTOWN® program, including the dormitories. Our dormitory-style accommodations are supervised by Community Tampa Bay staff and trained Volunteer Camp Counselors. To ensure an inclusive, safe and respectful environment for all participants, dormitory assignments are based on staff, trained Volunteer Camp Counselor, and participants’ self-disclosed social identities including gender identity and sexual orientation. I, volunteer/parent or guardian, understand that all staff and trained volunteer camp counselors are carefully screened, trained, and committed to upholding the highest standards of safety and inclusivity throughout the program. By signing below, I acknowledge and give consent for my child/myself to reside in dormitories under these arrangements.
*
I DO grant permission, consent, and agree to the above gender inclusion terms for myself/my child's residential stay at ANYTOWN®.
I do NOT grant permission, consent, and agree to the above gender inclusion terms for myself/my child's residential stay at ANYTOWN®.
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Parent/Guardian Contact Information
If the volunteer is a minor (under the age of 18), please have a parent or guardian fill out the following questions. If the volunteer is over the age of 18, they may use this opportunity to list a contact person that is not their parent/guardian.
Parent/Guardian's Name
*
First Name
Last Name
Relationship to the applicant
*
Please Select
Mother
Father
Grandparent
Foster Parent
Sibling
Other
Please describe your relationship to the applicant
Example: Girlfriend, Roommate, Best Friend, etc.
Contact Phone Number
*
Format: (000) 000-0000.
E-mail Address
*
johnnyappleseed@gmail.com
Emergency Contact Information
Emergency Contacts must be different from guardians. We will reach out to Emergency Contacts only when guardians are unavailable.
Emergency Contact Name
*
First Name
Last Name
Relationship to the applicant
*
Please Select
Mother
Father
Grandparent
Foster Parent
Sibling
Other
Please describe your relationship to the applicant
Example: Girlfriend, Spouse, Roommate, Best Friend, etc.
Emergency Contact Phone Number
*
Format: (000) 000-0000.
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Consent: Please read the following carefully. If the applicant is a minor, a parent/guardian is REQUIRED to fill out the following. If the applicant is 18 years of age or older, they may fill out the following.
Mandatory Volunteer Training Consent:
Volunteer Camp Counselor Training Dates are as followed: Saturday, April 18th 9:00am-4:00pm (Tampa) or Saturday, May 16th 9:00am-4:00pm (St. Pete). Once selected, Counselors are required to attend one of the offered trainings. Staff Day is required by all staff and Counselors to attend on Sunday, June 7th.
I understand that in order to be eligible to serve as an ANYTOWN® Volunteer Camp Counselor, I am required to attend and complete one of the two mandatory training sessions. I understand that I must attend Staff Day (the Sunday before an ANYTOWN® session begins) from start to finish. I understand that if I do not meet these requirements I will be ineligible to participate as an ANYTOWN® Volunteer.
*
I DO understand that I must meet the required training sessions to be eligible to volunteer at the ANYTOWN® program.
I do NOT understand that I must meet the required training sessions to be eligible to volunteer at the ANYTOWN® program.
Assumption of Risk:
The volunteer understands that community service activities may include work that may be hazardous to the volunteer. The volunteer hereby expressly and specifically assumes the risk of injury or harm, or loss or damage to property arising from participation in the activities. If the volunteer requires accommodations for special needs or abilities*, the volunteer must contact the Community Tampa Bay INC., whereby Community Tampa Bay INC., on a case by case basis, will review the accommodation request.
*
I have read and agree to the Assumption of Risk.
Content Material Consent:
I understand that ANYTOWN® is a youth leadership and diversity education program that deals with mature subject matters. Discussion topics may include values clarification, self-reflection, stereotypes and prejudice, interpersonal communication, identity, racism, sexism, homophobia, classism, genocide, power and privilege, and other issues of social justice. My/my child’s participation in ANYTOWN® is entirely voluntary and I am/my child is under no obligation to take part in the program. I realize that the ANYTOWN® program is exclusively under the auspices of Community Tampa Bay INC. and is their sole responsibility although the program is located on the Eckerd College campus. I understand that Participants and Volunteers may find ANYTOWN® to be an emotional experience. Throughout the program, Participants and Volunteers may experience confusion, anger, joy, sadness, frustration, hope and other emotions as they learn about the impact discrimination has on the lives of individuals. I affirm that I/my child has no known mental or emotional disorders or sensitivities that would interfere with participation and that I/my child is capable of handling the subject matter and emotional nature of this program.
*
I understand
Participation Consent:
I understand that in an emergency situation, there is a possibility that I/my child may be driven by Community Tampa Bay INC. employees, volunteers or representatives if the situation would warrant it. I also understand that, although Community Tampa Bay INC. has used great care to provide organization, supervision, instruction, and equipment for each activity, it is impossible for Community Tampa Bay INC. to guarantee Participants/Volunteers' absolute safety. I acknowledge that each Participant/Volunteer shares the responsibility for making an activity a safe experience for all Participants through appropriate behavior and conduct. I/my child agree(s) to follow directions of the activity leaders at ANYTOWN® and not deviate from the planned activities. I understand that Community Tampa Bay INC. reserves the right to dismiss me/my child from ANYTOWN® for any reason, including but not limited to verbal and physical aggression against any ANYTOWN® representative or other Participant/Volunteer, failure to follow safety or program instructions, or for any other disruptive behavior, if, in Community Tampa Bay’s sole discretion, my/my child’s continued participation would threaten the success of the program. If the Chief Executive Officer/Executive Director or Program Director must send my child home for any reason, I agree to pick up my child within four (4) hours of the call. I understand that I may be called at any time of the night or day to arrange for my child's transportation home and that I will be responsible for all costs associated with such transportation.
*
I understand
I have fully investigated the nature of ANYTOWN® and agree that I/my child will assume the risks of injury or damage that are inherent in any activity and that may occur as part of participation in the program. I understand that no insurance coverage may exist through Community Tampa Bay INC. to cover any claims that may arise out of my/my child’s participation in ANYTOWN®. I agree to bear all financial responsibility for any medical treatment arising from my/my child’s participation in ANYTOWN®. In consideration of the opportunity to participate in ANYTOWN®, I expressly agree and intend that my/my child’s participation in ANYTOWN® shall be undertaken at my/my child’s own risk and that none of Community Tampa Bay INC., its officers, directors, employees, lessors, volunteers, agents or assigns shall be liable for any losses, injuries, damages, claims, demands, actions or causes of action whatsoever which may arise out of or in connection with my/my child’s participation in ANYTOWN®, whether from acts of passive or active negligence on my/my child’s part, the part of Community Tampa Bay INC., its officers, directors, employees, lessors, volunteers, agents or assigns, or the part of third parties. I do hereby forever release, waive, discharge covenant not to sue, and agree to indemnify and hold harmless Community Tampa Bay INC., its officers, directors, employees, lessors, volunteers, agents and assigns (the “releases”) for any such losses, injuries, damages, claims, demands, actions, or causes of action.
*
I understand
Offsite Transportation Consent:
I hereby authorize Community Tampa Bay, INC. and its authorized employees, agents or representatives, to participate in any ANYTOWN® activities both on and off of the Eckerd College campus. I understand that this involves transportation, and I give my consent for myself/my child to be transported in a vehicle provided by Community Tampa Bay, INC. and/or a contracted service. I understand that the mode of transportation may include buses or vans and may take place on public roads. I understand that Community Tampa Bay, INC. will take all necessary precautions to ensure the safety of myself/my child during any transportation. In the event of an emergency during transportation, I authorize Community Tampa Bay, INC. or a contracted transportation service to seek medical attention for my child if needed. I understand that I, parent/guardian, will be notified as soon as possible if such an emergency occurs.
*
I understand and authorize consent for myself/my child to be transported offsite.
I do NOT understand and do NOT authorize consent for myself/my child to be transported offsite.
Photo & Video Release:
I understand that I/my child, alone or with other Participants and/or Community Tampa Bay INC. staff members, volunteers or representatives, may be interviewed, may provide written or oral statements, and/or may be photographed, recorded on film, audio tape, videocassette, or other visual and sound, computerized, telephonic, voice-mail or tape media (photographs and/or sound/image recordings) by Community Tampa Bay INC. and/or others approved by Community Tampa Bay INC. I hereby consent to the foregoing and grant permission, without reservation, to Community Tampa Bay INC. and/or those approved by Community Tampa Bay INC., to use, disclose, disseminate, copy, comment on, and/or publicize (i) any photographs, written or oral statements, and/or sound or image recordings; and (ii) my/my child’s name, age and city of residence, as Community Tampa Bay INC. may determine in its discretion in connection with furthering its goodwill, public education, promotional and/or fundraising activities, without review or further consent by me or my child and without any monetary compensation to me or my child. I hereby release Community Tampa Bay INC., its officers, directors, volunteers, employees, licensees, volunteers, agents and assigns from all claims that I or my child may have, or could in the future have, for any demand, claim, actions or causes of action arising out of the taking and/or use of the photographs and/or sound/image recordings as set forth herein: This photo & video consent and release shall continue in effect in perpetuity without expiration or limitation.
*
I DO grant permission, consent, and agree to the above photo and video release terms for my/my child's recording/images.
I do NOT grant permission, consent, and agree to the above photo and video release terms for my/my child's recording/images.
Evaluation Consent:
Community Tampa Bay INC. asks all participants to provide information that is used to evaluate its effectiveness and quality. This information includes questions about program outcomes and impact. This information is confidential and remains anonymous to the evaluators. Results of the evaluation are used to strengthen the program, educate others on what promotes diversity education and self-reflection in youth. On occasion, this includes the publication of evaluation results in professional and/or research publications. Your child's participation is extremely helpful for us to ensure the quality of the ANYTOWN® program and related efforts but is NOT required. Will you allow your child assist as described?
*
YES, I allow for my child/self to assist by participating in evaluating the ANYTOWN® program.
NO, I do NOT allow for my child/self to assist by participating in evaluating the ANYTOWN® program.
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Health History & Medical Release Form
The information on this form is NOT part of the acceptance process for ANYTOWN®. This information is gathered to assist in identifying appropriate care for the applicant. All medical information is confidential. This form must be completed by the parent(s)/guardian of minors applying for the Volunteer Camp Counselor position. Any changes to this form should be provided to the Program Director prior to the applicant's involvement in ANYTOWN®. Please provide detailed, complete, and accurate information so the staff members are aware of your child's needs. This form is kept on-site during the ANYTOWN® program.
Applicant Information
Please fill out the following to the best of your knowledge and accuracy. If there are changes made between now and June 1st 2026, please inform the Program Coordinator: maya@communitytampabay.org.
Insurance Provider
*
Example: Florida Blue
Please list all applicant's allergies (food, environment, medicine, etc.):
*
Example: Peanuts, Pollen, Penicillin
What are the applicant's reactions to the previously mentioned allergies? How are the reactions managed? Type "N/A" if no allergies were listed.
*
Example: Hives, I carry an epi-pen!
Dietary Needs or Restrictions:
*
Example: Vegetarian, Gluten-Free, Lactose Intolerant, etc.
Are there any other relevant medical conditions or medical information ANYTOWN® staff should know? Including but not limited to: physical, psychological, or medical conditions, recent injuries, recent or routine medical treatment(s), therapy or professional counseling, etc.
*
Does applicant take daily medication?
*
Yes
No
Other
Please list: 1. The name of the medication 2. Frequency taken 3. Dosage
*
1. Albuterol 2. Two x daily 3. One pump each
Authorization to Administer Medications
Please read the following question carefully.
Authorization to Administer Over-The-Counter Medications:
*
By checking this box, you are indicating that ANYTOWN® staff members ARE permitted to administer over-the-counter medications (such as Tylenol, Benadryl, Pepto-Bismol, etc.) as needed to you/your child.
By checking this box, you are indicating that ANYTOWN® staff members are NOT permitted to administer over-the-counter medications (such as Tylenol, Benadryl, Pepto-Bismol, etc.) as needed to you/your child.
Other Notes:
Example: Please don't give my child/applicant Benadryl.
Consent
Please read the following carefully. If the applicant is a minor, a parent/guardian is required to fill out the following. If the applicant is 18 years of age or older, they may fill out the following.
Medication Authorization:
I, the parent or guardian of applicant, expressly authorizes any Community Tampa Bay INC. representative to administer the medications I have listed in the Community Tampa Bay Application that was submitted by the Applicant or checked on the list above. All medication prescribed or over the counter must be given to staff upon arrival. I further authorize and grant permission for any Community Tampa Bay INC. representative to contact the prescribing physician(s) (or his/her designee) for such medication(s) in order to exchange information concerning the medication(s) listed in the Community Tampa Bay INC. Programs Application. The information provided on this form is correct and complete to the best of my knowledge, and I authorize the release of the medical information on this form as is pertinent to my child’s condition. Moreover, the applicant has permission to engage in program activities except as noted on this “Health History and Medical Release Form."
*
I consent
Emergency Release Agreement
Permission to provide necessary medical treatment or emergency care | A parent /guardian MUST sign this emergency release agreement for any applicant who is younger than 18 years old.
If any accident, injury or illness occurs which, in the sole judgment of Community Tampa Bay INC. representatives, requires immediate medical attention, I, the parent or guardian of applicant, hereby consent for any Community Tampa Bay INC. representative to obtain such emergency treatment, including hospitalization. I further consent to have my child transported to a medical facility and to the signing of any releases by Community Tampa Bay INC. representatives that may be required by any medical care provider. I understand that every effort will be made to notify me in the event of an emergency. In the event I cannot be reached in an emergency, however, I hereby expressly give permission to the physician or medical facility selected by the Chief Executive Officer, Executive Director, or Program Director to secure and administer treatment, including hospitalization. The medical information I have provided above is complete and accurate to the best of my knowledge.
*
I consent
By initialing this document, you are affirming that you have read, understand, and agree to its terms and conditions and that the information provided is true and accurate. (Parent/Guardian's initials if applicant is under 18):
*
Submit Form
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