Phone: 904-637-4720

Volunteer Application

VOLUNTEER APPLICATION

Thank you for your interest in volunteering at Bright Minds Youth Development summer camp. Our summer camp is a continuous 8 weeks from June through July. Our volunteers are required to work a minimum of 6 hours per day. We like for our volunteers to commit to a minimum of 4 consecutive weeks.

Please fill out the application as completely as you can, then hit the “SUBMIT” button at the bottom.

Date:

Name: Social Security Number:

Address:

City: State: Zip:

Home Phone: Cell Phone:

Email:

Drivers License Number: Date of Birth:

Employer/School: Occupation:

Employer/School Address:

City: State: Zip:

Work Phone:

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EDUCATION

High School: Month/Year Entered: Current Grade: Date Graduated:

College/University: Date Entered: Date Graduated:

Major/Minor:

Are you a licensed teacher? YesNo

Degree earned and effective date:

Fluency: Spanish YesNo Other, please indicate:

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CAMP/TEACHING/COMMUNITY CENTER EXPERIENCE

1. Years: Agency Name:

Address: Phone:

Your Position: Supervisor:

2. Years: Agency Name:

Address: Phone:

Your Position: Supervisor:

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CERTIFICATIONS (Email copies of certification cards to volunteer@brightmindsyouth.org)

CPRFirst AidLifeguardEMTTeachingTutoringOther

If Other, please list:

Please answer the following questions to the best of your ability:

1. Do you have childcare experience? YesNo If yes, age of the children:

2. Why do you want to volunteer for Bright Minds summer camp? Specify what characteristics and skills you feel you would bring to this position?

3. List subjects, activities that you could Lead or Assist:

Music: Dance: Arts/Crafts: Science: Cooking: Drama:

Chess: Reading: Math: Football: Soccer: Basketball:

Volleyball: Golf: Health/Fitness:

Other Sports: Specify sport(s):

Other Activities: Specify activity(s):

Do you play an instrument? YesNo If yes, what instrument(s):

4. Do you have any camp counseling or related experiences? YesNo

Please include role, age, location and dates:

5. What comes to mind when you hear the word, “role model?”

6. Do you have any physical limitations? YesNo If yes, please specify:

7. Do you have any tutoring experience? YesNo If yes, specify subjects:

T-Shirt Size Preference: XSSMLXLXXL Other size:

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REFERENCES (minimum of 3 required; at least 2 work references and 1 personal) If student and no work, at least 3 personal, not relatives.

PERSONAL - Other than relatives

1. Name: Phone: Address/City:

Relationship: Length of time known:

2. Name: Phone: Address/City:

Relationship: Length of time known:

3. Name: Phone: Address/City:

Relationship: Length of time known:

PROFESSIONAL - Current or Past Employers

1. Name: Phone: Address/City:

Relationship: Length of time known:

2. Name: Phone: Address/City:

Relationship: Length of time known:

3. Name: Phone: Address/City:

Relationship: Length of time known:

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REQUEST FOR CRIMINAL RECORD CHECK AND AUTHORIZATION

It is the policy of Bright Minds Youth Development, Inc. to do background checks on persons who are being considered for volunteering or employment. Inquiries may be made of Federal, State, or County records. We intend to do a lifetime background check concerning criminal convictions and sexual predator offences nationwide.

I hereby authorize Bright Minds Youth Development, Inc. to request any information which pertains to any record of convictions contained in any criminal file maintained on me, whether local, state or national. I hereby release said Bright Minds Youth Development, Inc. and /or police department from any and all liability resulting from such disclosure.

First Name: Middle Name: Last Name: Suffix:

Maiden Name:

Alias:

Address:

City: State: Zip Code:

Phone 1: Phone 2:

Email:

Social Security Number:

Birth date:

Driver’s License: State: Expires: