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1 Camp Patterson Volunteer Counselor Application 2015 Our volunteer counselors are what make Camp Patterson successful. We encourage youth ages 14 and older, and adults to take advantage of this opportunity for a rewarding summer of being a special friend and helper at Camp Patterson. A two-week commitment is required and training is provided. After we receive your application, you will be contacted regarding an interview. (Please complete all three pages) Send completed applications to: Everett Parks and Recreation Department Attn: Jane Lewis 802 E Mukilteo Blvd Please print legibly Everett WA 98203 Name: Age: First Last Male Female Birth Date: Address: City: State: Zip: Home Phone: Work Phone: Cell Phone: Email: School: Grade Completed: Parent/Guardian: EMERGENCY CONTACT (if not able to reach Parent or Guardian) Name: Relationship: Home/Cell Work Name: Relationship: Home/Cell Work Please check the sessions you wish to volunteer (two-week minimum volunteer service required): I am available for training June 25-26 from 10-3 at Camp Patterson I will attend a volunteer group interview/orientation on Wednesday, June 10th at 4:30pm at Spruce Hall in Forest Park and bring a parent and my social security card Week 1 June 29-July 2 Week 2 July 6-10 Week 3 July 13 – July 17 Week 4 July 20 – July 24 Week 5 July 27– July 31 Week 6….Aug 3 – Aug 7 Please describe your previous volunteer experience(s): - ---PAGE BREAK--- 2 Select your swimming ability: Lifeguard certified Completed advanced swimmer classes Taken lessons, am comfortable swimming in a lake Like to play in the water Don’t like to swim Can’t Select your canoeing and/or kayaking ability: Have been canoe/kayak certified before Have done extensive canoe/kayaking Paddled a few times Need more time in a boat Don’t like it Can’t Do you speak another language? Please explain (Including sign language) Do you have any special musical abilities? How many summers have you participated at Camp Patterson? Other camping experiences? Explain: Why do you want to volunteer at Camp Patterson? Pick your top 2 interests: Unit 1 & 2 – Elementary-aged children Sports and Games Unit 3 & 4 – Middle School Music and Movement Unit 5 & 6 – High School Arts and Crafts MEDICAL HISTORY Do you have: Yes No 1. Had any recent injury, illness or infectious disease? 2. Have any dietary restrictions? 3. Ever passed out/been dizzy during or after exercise? 4. Ever had seizures? 5. Any allergies? 6. Will you be bringing any medications to camp? Please explain any “yes” answers, noting number of the question(s): Do you have health issues that would affect your ability to safely participate in the day camp activities? Do you have any issues that we or the doctors need to be aware of in case of an emergency? Do you require any accommodation to make your volunteer experience a success? No If Yes, please explain: