Application Date
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By checking the box below, I confirm my availability to volunteer for the following dates.
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Event takes place at Camp Twin Lakes in Winder, GA
Required Volunteer Training
By checking the box below, I confirm my availability to attend the mandatory volunteer training.
Training is in Atlanta, GA
First Name
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Last Name
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Date of birth
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M-D-Y
Email Address
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Phone Number
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Street Address
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State
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Georgia Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
County
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Atkinson County Bacon County Baker County Baldwin County Banks County Barrow County Bartow County Ben Hill County Berrien County Bibb County Bleckley County Brantley County Brooks County Bryan County Bulloch County Burke County Butts County Calhoun County Camden County Candler County Carroll County Catoosa County Charlton County Chatham County Chattahoochee County Chattooga County Cherokee County Clarke County Clay County Clayton County Clinch County Cobb County Coffee County Colquitt County Columbia County Cook County Coweta County Crawford County Crisp County Dade County Dawson County Decatur County DeKalb County Dodge County Dooly County Dougherty County Douglas County Early County Echols County Effingham County Elbert County Emanuel County Evans County Fannin County Fayette County Floyd County Forsyth County Franklin County Fulton County Gilmer County Glascock County Glynn County Gordon County Grady County Greene County Gwinnett County Habersham County Hall County Hancock County Haralson County Harris County Hart County Heard County Henry County Houston County Irwin County Jackson County Jasper County Jeff Davis County Jefferson County Jenkins County Johnson County Jones County Lamar County Lanier County Laurens County Lee County Liberty County Lincoln County Long County Lowndes County Lumpkin County Macon County Madison County Marion County McDuffie County McIntosh County Meriwether County Miller County Mitchell County Monroe County Montgomery County Morgan County Murray County Muscogee County Newton County Oconee County Oglethorpe County Paulding County Peach County Pickens County Pierce County Pike County Polk County Pulaski County Putnam County Quitman County Rabun County Randolph County Richmond County Rockdale County Schley County Screven County Seminole County Spalding County Stephens County Stewart County Sumter County Talbot County Taliaferro County Tattnall County Taylor County Telfair County Terrell County Thomas County Tift County Toombs County Towns County Treutlen County Troup County Turner County Twiggs County Union County Upson County Walker County Walton County Ware County Warren County Washington County Wayne County Webster County Wheeler County White County Whitfield County Wilcox County Wilkes County Wilkinson County Worth County Other
Ex: Fulton County
Zip Code
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Gender
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Female Male
African American Asian Caucasian Hispanic Multi-Racial Native American Other
If other, please state your race
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Volunteer T-Shirt Size
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Small Medium Large XL 2XL 3XL 4XL
Have you ever been convicted of a crime?
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Yes
No
If yes, briefly explain the crime
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What is the highest level of education you have completed?
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High School Some college Associates Bachelors Masters Doctorate Professional degree
Please list all colleges and/or professional schools you have attended.
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Are you currently a student?
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Yes
No
If yes, which university/program do you attend?
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Auburn HDFS GSU Nutrition KSU Nursing KSU Exercise Science Mercer Pharmacy UGA Pharmacy UGA Community Health UGA HDFS Other
If other, please list.
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Do you need to fulfill required service hours for your program?
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Yes
No
Are you currently an employee of Children's Healthcare of Atlanta?
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Yes No
Please list current and former employers from the last two years
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Have you ever had difficulties performing a job?
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Yes
No
If yes, what difficulties?
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What are your goals for volunteering at camp?
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What are you looking forward to most about volunteering?
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What concerns you most about working at camp?
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Will this be the first time working with an overweight or obese population?
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Yes
No
In what capacity have you worked with this population before?
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What skills/ qualifications do you possess that will make you a valued camp volunteer?
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Is there anything that would limit your involvement in camp?
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Have you volunteered with Camp Strong4Life before?
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Yes
No
If yes, how many years have you volunteered with us?
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1 2 3 4 5
Which volunteer position are you interested in?
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Nurse Counselor Other
If you are applying as a medical professional, please list your license number.
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Please indicate your specialty.
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Are you allergic to any medications?
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Yes
No
Please list medications you are allergic to
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What is your reaction to ______ ?
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Do you have any environmental allergies?
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Yes
No
If yes, please list environmental allergies and reactions to those allergies
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Are you allergic to eggs?
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Yes
No
Are you allergic to shellfish?
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Yes
No
Are you allergic to tree nuts?
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Yes
No
Please Select
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Cannot eat tree nuts Cannot be in the same room as tree nuts Other
If other, please explain
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Are you allergic to peanuts?
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Yes
No
Please select
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Cannot eat peanuts Cannot be in the same room as peanuts Other
If other, please explain
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Do you have any other food allergies not listed above?
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Yes
No
Please list other food allergies and describe the reaction to those foods.
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Are you a vegetarian?
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Yes
No
Do you eat red meat?
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Yes
No
Do you eat pork?
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Yes
No
Are you gluten intolerant?
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Yes
No
Are you lactose intolerant?
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Yes
No
Are there any other food preferences/restrictions we should be aware of?
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Yes
No
If yes, please explain below
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Please initial to confirm that you have a regular diet with no restrictions.
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Emergency Contact #1 Name
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Emergency Contact #1 Relationship
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Emergency Contact #1 Phone Number
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Emergency Contact #2 Name
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Emergency Contact #2 Relationship
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Emergency Contact #2 Phone Number
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By entering my name here, I agree that I am the applicant and the information given in this application is accurate to the best of my knowledge.
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