Spinal Cord Injury (SCI) Camp September 15, 2022
At this time we are only accepting submissions from volunteers with a RN/LPN/PCA/CNA background
Full Name*
Nickname
I am 18 years of age or olderI am between 13 and 17. I will be supervised by my parent or guardian for the duration of the camp weekend
Gender ---FM
E-Mail Address*
Address
City
Zip code
Home Phone Number
Mobile Phone Number
Employer*
Primary Language*
Secondary Languages
List type of professional license held* : OTPTRNCNAMDStudentOther
If Other
Please initial if you will attend the weekend camp from Thursday afternoon until Sunday at noon:
We would like to accommodate you if we can so please let us know if you will require a late check-in or early check-out time.
How did you hear about Camp With A Ramp?
SCI and Volunteer Experience:
Do you have experience working with individuals with Spinal Cord Injuries?
Please give a brief description of your experience with Spinal Cord Injuries, your hobbies, interests, and areas of expertise; what you feel you can contribute to the camp weekend:
Please check the areas you are interested in volunteering:
Animal interactionTherapeutic RidingArts and craftsSportsFishingSunrise HikesDirecting to cabins/activitiesPlanning/CoordinatingMedical CarePicture DVDCheck in/outClean upClericalLuggage assistanceEducationFish HatcheryTransfersPersonal careMovie nightGamesTransportation
Would you be willing to bring other individuals luggage in your vehicle to the camp weekend?---YesNo
Would you be willing to give others a ride to the camp weekend in your vehicle? ---YesNo
Do you have any additional special considerations?
Medical History:
Do you have any of the following conditions?
History of heat related illness ---YesNo
Cardiovascular disease ---YesNo
Asthma or other respiratory problems ---YesNo
Are you hypersensitive to insect stings? ---YesNo
Do you have a condition that might be affected by volunteering for this weekend camp (i.e. heat sensitivity, change in altitude, etc.) ---YesNo (If yes, please explain):
List any allergies:
List any special dietary needs/restrictions:
Emergency contact 1* :
Phone number* :
Relationship* :
Emergency contact 2:
Phone number:
Relationship:
Tee shirt size (select one) ---SMLXLXXLXXXL
How do you prefer to be contacted? ---phoneemail
You will be contacted shortly with information on a mandatory volunteer orientation meeting. Please feel free to email us with any questions or concerns.
Thank you!!
Volunteer@campwitharamp.com