Volunteer Application

Volunteer Application

Date:

Name:

Address:

City: State: Zip:

Home Phone: Cell Phone:

Email:

Drivers License Number: Date of Birth:

Employer/School: Occupation:

City: State: Zip:

--------------------------------------------------------------------------------

EDUCATION

High School: Date 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:

--------------------------------------------------------------------------------

CAMP/TEACHING/COMMUNITY CENTER EXPERIENCE

1. Years: Agency Name:

Address: Phone:

Your Position: Supervisor:

2. Years: Agency Name:

Address: Phone:

Your Position: Supervisor:

What locations are you interested in this summer?
Bartram Springs ElementaryHenry Kite ElementaryBibb County
(Disclaimer: It is recommended that you select multiple locations. All staff will be assigned to a location based on the needs of BMYD. To select multiple locations press CONTROL then left-click.)

--------------------------------------------------------------------------------

CERTIFICATIONS (Email copies of certification cards to [email protected])

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: —Please choose an option—LeadAssist Dance: —Please choose an option—LeadAssist Arts/Crafts: —Please choose an option—LeadAssist Science: —Please choose an option—LeadAssist Cooking: —Please choose an option—LeadAssist Drama: —Please choose an option—LeadAssist

Chess: —Please choose an option—LeadAssist Reading: —Please choose an option—LeadAssist Math: —Please choose an option—LeadAssist Football: —Please choose an option—LeadAssist Soccer: —Please choose an option—LeadAssist Basketball: —Please choose an option—LeadAssist

Volleyball: —Please choose an option—LeadAssist Golf: —Please choose an option—LeadAssist Health/Fitness: —Please choose an option—LeadAssist

Other Sports: —Please choose an option—LeadAssist Specify sport(s):

Other Activities: —Please choose an option—LeadAssist 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:

--------------------------------------------------------------------------------

REFERENCES (minimum of 3 required; at least 2 school/work references and 1 personal) No 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:

--------------------------------------------------------------------------------

After you fill out all relevant information above, hit the SUBMIT button and someone will contact you soon.