• Image field 51

  • Staff Registration

    MADA Camp
  • Date of Birth (18+ required)*
     - -
  • Format: (000) 000-0000.
  • Gender*
  • Which of the following best describes you?*
  • Which of the following best describes you?*
  • Do you know American Sign Language (ASL)?*

  • ASL Competence

  • What is your current ASL Skill Level?*

  • Select Role(s) / Position(s)

  • Role / Position*

  • Certifications / Licenses

  • Do you have any of the following medical certifications or licenses? (Check all that applies)*

  • Staff Questions

  • What age group do you prefer working with?*
  • Do you have a background in any of the following? (Check all that applies)*
  • Do you have reliable transportation to and from the camp? *
  • Do you have your own camping gear (such as a tent, sleeping bag, etc.)? *

  • Emergency Contact Information

  • Emergency Contact is Deaf or Hearing?*
  • Format: (000) 000-0000.

  • Mandated Reporter (NY REQUIRED)

  • Please read the Summary Guide for Mandated Reporters. 

    Under NY Social Services Law §413, individuals working with minors are mandated reporters. 

    Mandated reporters are required to report suspected child abuse or maltreatment when they are presented with a reasonable cause to suspect child abuse or maltreatment in a situation where a child, parent, or other person legally responsible for the child is before the mandated reporter when the mandated reporter is acting in their official or professional capacity. “Other person legally responsible” refers to a guardian, caretaker, or other person 18 years of age or older who is responsible for the care of the child.

  • Electronic Signature

  • Date*
     - -
  • Should be Empty: