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Parent Tools/Advice

Home
About CCK
Virtual Tour
Become a Camper
Get Involved
Donate
- US Dollars
- Planned Giving
Parent Tools/Advice

Program Volunteer Application

Please complete this form completely and accurately. Upon completion of the application, a member of our volunteer recruiting team will contact you with more information. Thank you for your interest in volunteering at The Center for Courageous Kids!

Step 1 of 9 - Personal Information

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Title
First Name*
Last Name*
Middle Initial*
Email Address*
Date of Birth*
MM slash DD slash YYYY
Gender*
- Male
- Female
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Home Phone Number
Cell Phone Number*

Have you volunteered with us before?
- Yes
- No
If so, When?
How did you hear about Camp? Are you affiliated with a partnering group or hospital?*
Day and Ongoing Volunteers: Please check which positions you are interested in:
- Barn
- Woodshop Cutters
- Housekeeping
- Maintenance
- Lifeguard
- Dining Hall
Please list days and times available:*
Family Weekend Volunteers (3 days):
- Den Counselor
- Program Counselor
Summer Camp Volunteers (1 week):
- Den Counselor

Why do you want to work with children who have life-threatening illnesses?*
What experience do you hope to get out of camp?*

High School
High School (Include City/State):*
Dates Attended*
Did you graduate?*
- Yes
- No
College
College (Include City/State):
Diploma/Degree/Certification:
Dates Attended:
Graduate School/Other
Graduate School/Other
Diploma/Degree/Certification:
Dates Attended:
Please mark any certifications (We reserve the right to request copies of any marked certifications):*
- First Aid
- CPR
- Lifeguard
- Other
- None
Please list any languages you speak fluently (other than English):

Employer*
Supervisor's Name*
First Last
Employer's Phone Number:*
Employer's Email:*
Employment Start Date:*
MM slash DD slash YYYY
Employment End Date:
MM slash DD slash YYYY
Your Job Title:*

Camp Name
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Supervisor's Name
First Last
Employer's Phone Number
Employer's Email
Employment Start Date
MM slash DD slash YYYY
Employment End Date
MM slash DD slash YYYY
Your Job Title

Reference #1
Reference Name (non-family member)*
First Last
Relationship*
Reference Occupation*
Reference Email Address*
Reference #2
Reference Name (non-family member)*
First Last
Relationship*
Reference Occupation*
Reference Email Address*

Has your name ever appeared on a sex offender registry?*
- Yes
- No
Have you ever been convicted of any crime except a minor traffic offense?*
- Yes
- No
Has your driver’s license ever been revoked or suspended?*
- Yes
- No
Have you ever been fired for cause or suspended/expelled from school?*
- Yes
- No
If you answered Yes to any of the above questions, please explain:

The facts set forth in my application are true and complete. I understand that if accepted, false statements on my application shall be considered sufficient cause for dismissal. I authorize the use of any information on this application and attached supplements to verify my statements, and I authorize Camp to contact the past employers, schools, and all references listed above.
I agree to the terms set forth in the above agreement. I understand that by selecting YES below, I give my consent to the above agreement (equivalent to my written signature).*
- Yes
Today's Date*
MM slash DD slash YYYY
If applicant is under 18: As the parent/guardian of applicant, I agree to the terms set forth in the above agreement. I understand that by selecting YES below, I give my consent to the above agreement (equivalent to my written signature).
- Yes
Today's Date*
MM slash DD slash YYYY

Δ

Courageous Partners

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Gold Ribbon Camp Accredited

ADDRESS
1501 Burnley Road
Scottsville, KY 42164

PHONE
270.618.2900

EMAIL
info@courageouskids.org

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