Volunteer Application

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Thank you for your interest in volunteering at Camp Independence! Volunteers must be 21 years of age or older at the time of camp. Former campers applying for the Leader-in-Training program should be 19 to 20 years of age and have attended Camp Independence previously as a camper.

Camp Independence is for campers ages 8-18. Camp dates are Sunday, July 31st to Friday, August 5th, 2016. Volunteers should expect to arrive one day prior to camp on Saturday, July 30th.

Please Note:

Upon receipt of your completed application, you will be sent a confirmation email. Completing the application does not guarantee your acceptance to camp. If you are a new volunteer to Camp Independence, you will receive information on how to sign-up for a brief phone interview.

Prior to attending camp, all volunteers must complete a Criminal Background check. The online background check will be completed through S2Verify at no cost to you. You will receive an email with instructions for completeing the check once your application has been processed and reviewed.

Applications are due by June 1, 2016

Important Tips for Completing this Application

This application will take you approximately 15 to 30 minutes to complete, depending on if you are a new or returning volunteer.

If you need to save your work and return later, you will have the option to do so after completing the first form. If at any point, you choose to Save & Return Later, you will need to take down the Return Code to enter when you come back to the application. Please be sure to save this code somewhere safe so you can reference it when returning to the application. Note: each page of the application has an unique return code so you'll need to save the code for each page you are trying to return to.

DO NOT begin this application more than once! Doing so will create multiple entries in our system. If you are experiencing issues with the application or having trouble returning to your saved work, please contact us at 404-785-6735 or email campindependence@choa.org.

Before beginning the application, it may be helpful to have the following items and information available.

Emergency contact info (other than parent), including name and phone number(s)
Your Primary Care Physician name and phone number
Your Specialist name and phone number (if applicable)
A list of your medications, including: medication name, dosage, day(s), times, and frequency given (if applicable)
New Volunteers only - the name, phone, and email for 3 professional references

The following documents must be submitted as part of the volunteer application. You will have opportunity to upload the documents in this online application. Hint: You can use your smart phone to take a photo of the documents and upload.
If you are unable to upload the documents, you can fax to 404-785-6747 or email to campindependence@choa.org.

A copy of your current Immunization Certificate or records (see below for required immunizations)
A copy of your Driver's License

Your privacy is important to us. All information submitted through this application is stored in REDCap, a secure, HIPPA compliant web application used to manage our camp database

Required Immunizations for Camp Volunteers:

- MMR (Measles, Mumps, Rubella) - Two (2) doses of MMR Vaccine OR proof of Immunity to MMR by Blood Titer
- TB (Tuberculosis) testing - Proof of negativeTB test within one year of camp start date
- Varicella (Chickenpox) - Two (2) doses of Varicella Vaccine OR proof of Immunity to Varicella by Blood Titer
- TDAP (Tetanus, Diphtheria, & Acellular Pertussis) - Proof of One (1) Tdap Vaccination

Today's Date:

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First Name

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Last Name

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Name you go by

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Street Address

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City

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State

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Zip

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Primary Phone Number

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Alternative Phone Number

Email Address

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Date of Birth

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Gender

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Male

Female

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T-shirt Size

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Do you have any special dietary needs?

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Yes

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Please select any special dietary needs.

If more than one applies, select Other and list all dietary needs in the space provided.

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Please explain:

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Please upload a clear copy of your Driver's License here. Hint: You can use your smart phone to take a photo and upload it.

If you are unable to complete this step, please fax or email a clear copy of your DL to 404-785-6747 or campindependence@choa.org.

Upload file

Emergency Contact Full Name

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Relation to Applicant

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Primary Phone Number

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Alternate Phone Number

Are you an employee at Children's Healthcare of Atlanta?

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Yes

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Job Title

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Department

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Manager's Name

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ACTION REQUIRED: Children's employees should print and complete the below Camp Attendance Form. Obtain your Department Manager's signature for approval to attend camp and forward the form to Risk Management. Fax and address information for Risk Mgmt department is included on the form.

If you are unable to print this form while completing the application, email campindependence@choa.org to request the form by email.

Attachment:CAMP ATTENDANCE FORM.pdf

Occupation

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Employer/School

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Supervisor's Name

Supervisor's Phone Number

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