CAMP OPPORTUNITY STAFF APPLICATION--2015
PLEASE CHECK WHICH CAMP(S) YOU WOULD LIKE TO ATTEND
July 18 – July 24, 2015 (ages 11-13)
June 20 - June 26, 2015 (ages 8-10)
Name:
Age:
Birthdate:
Address:
City
Phone:
State
Zip
Email:
I was referred to Camp Opportunity by:
In case of emergency, contact:
Relationship:
Phone:
Occupation/Job Title:
Employer:
Supervisor’s Name:
Phone:
Are you currently a student?
No
Yes
High School:
College/Major:
Languages Spoken:
Do you have a current Lifeguard Certificate?
No
Yes
Please list any special interest/training/certification: (ie: music, dance, sports, First Aid, CPR)
Please indicate any special dietary needs:
T-Shirt Size:
S
M
L
XL
XXL
REFERENCES – NEW APPLICANTS ONLY: Please have two people (not relatives)
complete and mail the attached Personal Reference Questionnaire form at the end of this
application. You may also provide additional letters of recommendation, if desired.
Please complete all pages, sign and return ASAP to: John Skinner
Camp Opportunity
PO Box 1135
Capitola, CA 95010
John Skinner
Camp Opportunity PO Box 1135 Capitola CA 95010
www.campopp.org
(831) 239-2323
CAMP OPPORTUNITY STAFF APPLICATION--2015
Do you have any previous camp counseling experience?
Do you have any previous experience working with at risk children?
If yes, please describe (use additional paper if necessary):
No
No
Yes
Yes
Please check all the words below which you believe accurately describe you:
Timid
Tactful
Quiet
Secure
Organized
Awkward
Gentle
Mature
Relaxed
Considerate
Impulsive
Patient
Impatient
Sarcastic
Stubborn
Abrasive
Intelligent
Funny
Modest
Cautious
Kind
Insecure
Trustworthy
Outgoing
Nervous
Angry
Studious
Motivated
Social
Dramatic
Loving
Creative
Selfish
Verbal
Compassionate
Team player
List three strengths you have in working with children (be specific)
1.
2.
3.
List three areas in which you can improve related to working with children (be specific)
1.
2.
3.
Have you ever been arrested for a criminal offense?
Have you ever been convicted of or plead guilty to a crime?
Have you ever been arrested for sexual misconduct?
Have you ever been convicted of or plead guilty to sexual misconduct?
No
No
No
No
Yes
Yes
Yes
Yes
If you answered “Yes” to any of the above, please list the date(s) of the arrest(s) and any facts
and circumstances surrounding the arrest(s). Being arrested does not automatically exclude
you from consideration. If you meet the requirements, you will be able to explain the
circumstances of your arrest. (use additional paper if necessary)
John Skinner
Camp Opportunity PO Box 1135 Capitola CA 95010
www.campopp.org
(831) 239-2323
CAMP OPPORTUNITY STAFF APPLICATION--2015
VOLUNTEER RELEASE AUTHORIZATION AND APPLICANT STATEMENT
Application information
I certify that all information in this application is true and complete. I understand that any false
information or omission may disqualify me from further consideration for volunteer service and
may result in my dismissal, if discovered, at a later date.
References
I understand that Camp Opportunity requires information from me to evaluate my qualifications
for volunteer service. I authorize and release personal references, employers (past and present),
and, if necessary, other applicable entities to answer questions in regards to volunteer work,
employment, ability, character and, if applicable, driving history.
Background Check Information
I understand that for the protection of campers and staff, all adults (age 18 and over) must
voluntarily complete a background check. I authorize Camp Opportunity to receive the
background check information and release Camp Opportunity from responsibility for this
investigation. I understand the requested information is for the sole purpose of gathering accurate
information for volunteer services at Camp Opportunity and that all information will be handled
with respect to my confidentiality. For anyone under 18 years of age, parents or legal guardians
can give permission for a background check.
I am over the age of 18, and am aware that I am required to be fingerprinted for a
background check (Live Scan). I understand that a Live Scan form will be sent to me
from Camp Opportunity and I will need to take that to a Live Scan location in my area to
complete the background check prior to starting volunteer service.
Camp Opportunity Policies
I agree to fully abide by the rules of Camp Opportunity and I am aware that I will be provided with
additional training and explanation of camp policies and procedures.
I understand that Camp Opportunity is a clean and sober environment and possession/use of
non-prescription drugs or alcohol will not be tolerated.
I understand that while I am volunteering at Camp Opportunity, I am not to leave the grounds at
any time without express permission from camp administers. I understand that if I have a valid
driver’s license and proof of insurance, I may be asked to assist in transportation of campers (if I
am over the age of 25) or transportation of adult staff (if I am over of the age of 18), and in such
circumstances, I will be required to provide appropriate documentation.
Date:
Name of Applicant:
Signature:
Date:
If under 18,
Parent/Guardian Name:
Signature
John Skinner
Camp Opportunity PO Box 1135 Capitola CA 95010
www.campopp.org
(831) 239-2323
CAMP OPPORTUNITY STAFF APPLICATION--2015
VOLUNTEER HOLD HARMLESS AGREEMENT FOR CAMP OPPORTUNITY
Happy Valley Conference Center
Santa Cruz, California
If under 18:
I, the undersigned, am the parent/guardian of
, and he/she is
covered by private health care insurance. My son/daughter shall be serving as a volunteer in
connection with Camp Opportunity, sponsored by Camp Opportunity, Inc., and do
acknowledge that there is certain potential for personal injury in connection with their duties.
I do hereby indemnify and hold harmless CAMP OPPORTUNITY, INC., and its volunteers,
officers, directors, and employees, and the County of Santa Cruz, its volunteers, officers,
agents, and employees, from any and all liabilities, claims, actions, demands, damages,
losses, attorney fees, costs or expenses of any kind arising from death, personal injury,
property damage, or any other cause based or asserted by the undersigned serving as a
volunteer in connection with Camp Opportunity.
If 18 or over:
I,
, am covered by private health care insurance. I shall be
serving as a volunteer in connection with Camp Opportunity, sponsored by Camp
Opportunity, Inc., and do acknowledge that there is certain potential for personal injury in
connection with my duties.
I do hereby indemnify and hold harmless CAMP OPPORTUNITY, INC., and its volunteers,
officers, directors, and employees, and the County of Santa Cruz, its volunteers, officers,
agents, and employees, from any and all liabilities, claims, actions, demands, damages,
losses, attorney fees, costs or expenses of any kind arising from death, personal injury,
property damage, or any other cause based or asserted by the undersigned serving as a
volunteer in connection with Camp Opportunity.
Date:
Name:
Signature:
Address:
Phone:
John Skinner
Camp Opportunity PO Box 1135 Capitola CA 95010
www.campopp.org
(831) 239-2323
CAMP OPPORTUNITY STAFF APPLICATION--2015
Personal Reference Questionnaire for:
How long have you known the applicant?
In what capacity do you know the applicant?
Please check all the words below which you believe accurately describe the applicant:
Timid
Tactful
Quiet
Secure
Organized
Awkward
Gentle
Mature
Relaxed
Considerate
Impulsive
Patient
Impatient
Sarcastic
Stubborn
Abrasive
Intelligent
Funny
Modest
Cautious
Kind
Insecure
Trustworthy
Outgoing
Nervous
Angry
Studious
Motivated
Social
Dramatic
Loving
Creative
Selfish
Verbal
Compassionate
Team player
Have you observed the applicant working with children?
No
Yes
Is the applicant respected by you/others for their work with children?
No
Yes
What degree of success do you feel the applicant would have with 8 - 13 year olds?
Exceptional
Above Average
Average
Below Average
Poor
What is your experience observing/working with the applicant in a group or on a team, and
what can you say about their ability to work with others as a team member?
Additional comments (please use additional paper if necessary):
Signature:
Name:
Date:
Phone:
Please complete and return to the address at the bottom of the page as soon as possible.
Thank you for your help!
John Skinner
Camp Opportunity PO Box 1135 Capitola CA 95010
www.campopp.org
(831) 239-2323
CAMP OPPORTUNITY STAFF APPLICATION--2015
Personal Reference Questionnaire for:
How long have you known the applicant?
In what capacity do you know the applicant?
Please check all the words below which you believe accurately describe the applicant:
Timid
Tactful
Quiet
Secure
Organized
Awkward
Gentle
Mature
Relaxed
Considerate
Impulsive
Patient
Impatient
Sarcastic
Stubborn
Abrasive
Intelligent
Funny
Modest
Cautious
Kind
Insecure
Trustworthy
Outgoing
Nervous
Angry
Studious
Motivated
Social
Dramatic
Loving
Creative
Selfish
Verbal
Compassionate
Team player
Have you observed the applicant working with children?
No
Yes
Is the applicant respected by you/others for their work with children?
No
Yes
What degree of success do you feel the applicant would have with 8 - 13 year olds?
Exceptional
Above Average
Average
Below Average
Poor
What is your experience observing/working with the applicant in a group or on a team, and
what can you say about their ability to work with others as a team member?
Additional comments (please use additional paper if necessary):
Signature:
Name:
Date:
Phone:
Please complete and return to the address at the bottom of the page as soon as possible.
Thank you for your help!
John Skinner
Camp Opportunity PO Box 1135 Capitola CA 95010
www.campopp.org
(831) 239-2323