2015
Dear Camp Buddy,
I hope you are having a good year. It is hard to believe that summer will soon be here. With thoughts of summer come memories of the DDS Summer Stars Day Camp.
First of all, I would like to thank you for your interest in serving as a volunteer for the Summer Stars Day Camp. Buddies are the reason the camps are so successful.
Enclosed is the 2015 Volunteer Buddy Packet. Please take a moment to look over the information. Kindly complete the application, and return it to us so we can plan for the coming season. Prior to volunteering, you will receive confirmation of your volunteer hours. In addition, you will be asked to participate in a Buddy orientation.
I look forward to seeing you this summer. Don’t hesitate to give me a call if you have any questions or if you would like to discuss anything. I can be reached at 717-274-3493.
Sincerely,
Jessica Penchard
VP Public Relations & Development
PERSONAL Check if over 16 years of age ______
*Full Name ______*Home Phone No. ______
*Home Address: ______*City ______*State ______*Zip ______
*Emergency Contact Person ______Contact Relationship ______
*Emergency Contact Phone No. (Day) ______(Evening) ______
*Most Recent Employer ______Position Held ______
*Employer Address ______*City ______*State _____*Zip ______
2015 DAY CAMP PROGRAM – Check all dates you would like to volunteer
Camp 1 Camp 2 Camp 3 Camp 4 Camp 5
June 8-11 June 22-25 July 20-23 July 27-30 Aug.3-6
9am-12 noon 9am-3pm 9am-3pm 9am-3pm 9am-12noon
Ocean Fun Safari Life Camp Mack Down on Circus Adventure The Farm
____ Mon .8 ____Mon. 22 ____Mon.20 _____Mon.27 ____Mon 3
____Tues. 9 ____Tues. 23 ____Tues.21 _____Tues.28 ____Tues.4
____Wed. 10 ____Wed. 24 ____Wed.22 _____Wed.29 ____Wed. 5
____Thurs.11 ____Thurs. 25 ____Thurs.23 _____Thurs.30 ____Thurs.6
(Over)
PREVIOUS VOLUNTEER POSITIONS
*Organization ______Phone No.______
*Address______*City ______*State____*Zip______
* Period of Service ______
*Organization ______Phone No.______
*Address ______*City ______*State____*Zip______
* Period of Service ______
*Are you volunteering for a school project? _____yes _____no
If so, which school do you attend?______
*Do you consider yourself strong and in good physical condition? ____yes ____no
*Can you swim? ____yes ____no
Hobbies and Interests:______
REFERENCES
Name ______Address ______
Phone Number ______How Long Have You Known Each Other ______
Name ______Address ______
Phone Number ______How Long Have You Known Each Other ______
(Over)
BACKGROUND DATA Please answer the following questions by circling the appropriate answer. If you answer “Yes” to any of the questions, please explain in REMARKS:
YES NO Have you ever been under the restriction of a Protection from Abuse (PFA) order?
YES NO Have you ever been convicted of offenses involving the sexual or physical abuse of
children?
YES NO Have you ever been convicted of offenses involving the sexual or physical abuse of
adults?
YES NO Have you ever lived in another state or district? If yes, where?______
______
*AUTHORIZATIONS Please circle the appropriate response:
YES NO I authorize the Developmental and Disability Services of Lebanon Valley
(DDS) to conduct a criminal record’s check.
YES NO I authorize my name and/or photograph taken at DDS activities to be used for
public relations purposes. Please list the name you want used in any news release:
______
REMARKS
______
SIGNATURE: DATE:
______
(Over)