| STAFF USE ONLY: T_____ C_____ A_____ J_____ D_____ Hopkins District Day Camp: 2009 Cubs in Space ADULT APPLICATION PLEASE READ THE VOLUNTEER SECTION OF THE APPLICATION COVER LETTER BEFORE PROCEEDING! Name: ____________________________________ Pack: _________________ Address: __________________________________ City/State: _______________ Zip Code: _______ Home Phone (_____) _____________ Work Phone (_____) ________________ Birth date: __________ Email Address: ___________________________________ (We will NOT share your email address with anyone) Is a Scout attending Day Camp with you: _YES _NO Name: __________________________ Pack #: ______ 5 Day Volunteer: _Mon,Tue,Wed,Thu,Fri 4 Day Volunteer: _Mon,Tue,Thu,Fri or _Mon,Tue,Wed,Thu or _Tue,Wed,Thu,Fri 3 Day Volunteer: _Mon,Thu,Fri or _Tue,Wed,Fri or _Tue,Wed,Thu 1 or 2-Day Volunteers are not required to submit an application. You will be considered a Visitor (Remember � you can take only one Scout discount per adult volunteer. Discount corresponds to number of days volunteered) Position at Camp: (Check one) _ Squad Leader (Overall leader for 8-10 boys, like a Den Leader, you will be assigned assistants � 5 Day Volunteer) SQUAD LEADER POSITION MUST HAVE CURRENT YOUTH PROTECTION TRAINING _ Den Walker (If we do not get enough leaders, some walkers will be assigned as squad leaders) Squad Leader and Den Leader Note: Barring staffing problems, we will place you with boys from your Pack _ Station Volunteer (number your top 3 choices and circle if we can assign you as staff in charge of an area) YOU MUST BE BSA REGISTERED AND YOUTH PROTECTION TRAINED TO WORK A STATION ___ Adventure (theme based) ____ Science/Nature ____ Sports ____ Scout Skills ____ Any ____ Shooting Sports (Slingshot -- requires � day certification course) All 3, 4 and 5 Day Adult Volunteers MUST BE Trained - Training will be held on Tuesday, June 16th, 2009 from 7:00-9 PM at the Scout Office. Please notify us ASAP if you will be unable to attend! Registrations and Certifications: Currently registered in Scouting? _YES _NO - Must be YES for Station/Staff Position - Attach Copy of Registration Card Circle one: Pack / Troop: _________ District: ____________________ Current Position: _________________ Current Youth Protection Training _YES _NO - Must be YES for Squad Ldr/Station/Staff Position - Attach Copy of Certification CPR Trained _YES _NO First Aid Trained _YES _NO Attach Copy of Certification(s) Medical Training: (Include a copy of your most recent certification � required for Camp Inspection) Please circle your current status of medical training: None EMT RN LPN MD Other _________________ T-Shirts: 1 FREE shirt w/ 3, 4 or 5-day volunteer. A larger shirt is better than one too small!! Check size! Adult: __Small __Medium __Large __Extra Large __Double Extra Large Number of shirts: 1 FREE shirt plus _____ additional shirts @ $10.00/shirt ($12.00 XXL) = $ ________ enclosed. Medical Information: (No one will be allowed in camp without this form!) I have attached the required medical form to this registration. Initial Here: . Make one check for the entire family payable to BSA/BAC and attach the check to the Hopkins Day Camp Family Tally Sheet. I understand that by registering for the days stated above, I am committing to be present at Day Camp during that time. If, for any reason, I cannot fulfill my commitment, I will notify the Camp Director as soon as possible. I have read the Application Cover Letter and understand all of the duties expected of me during camp. Signature: _________________________________________________________ Date: ___________________ | 
