All fields are required unless marked as (optional)
First Name
Last Name
Age by July 14, 2024
Date of Birth (Must be 18 or older to apply)
Gender ---MaleFemale
Phone Number
Email Address
Confirm Email Address
Home Address Street Address
City
State
Zip Code
Week Preference Please rank your preferred week based on availability with "1" being your most preferred and "2" being your least preferred. If you are not available a certain week, choose "Not Available". Week 1: July 14 to July 21, 2024: ---Not Available12 Week 3: July 28 to August 4, 2024: ---Not Available12
T-Shirt Size ---smallmediumlargex-largexx-large
AYF Member? ---YesNo If yes, which chapter (optional)
Details about counselor orientation coming soon. You will be required to get CPR certified on your own.
Emergency Contact #1
Name
Relationship
Emergency Contact #2
Phone number
Camp Experience
Dates (optional) Camp/Director (optional) Staff or Camper? (optional)
This information is confidential and will be used in case of emergency
Health History
Have you ever been hospitalized? ---YesNo If yes, explain (optional):
Allergies
Medications
Dosage/Frequency
Physician's Name
Physician's Number
Health Insurance Carrier
Health Insurance Group Number
Health Insurance Agreement / Policy Number
Additional Questions
Do you have any dietary restrictions? ---YesNo If yes, please explain (optional):
Do you smoke? ---YesNo If yes, can you handle not smoking for a week?
Do you have any of the following certifications? (optional) CPRFirst AidEMTLifeguardNursing
Have you ever been convicted of a crime? ---YesNo If yes, please explain (optional):
I hereby authorize Armenian Youth Camp to publish the photographs/videos taken of me and/or my name, for use in the Armenian Youth Camp website and social media accounts. I release Armenian Youth Camp from any expectation of confidentiality for myself and that I have the authority to authorize Armenian Youth Camp to use my photographs/videos and name. I acknowledge that since participation in publications and websites produced by Armenian Youth Camp is voluntary, I will not receive financial compensation. I further agree that participation in any publication and website produced by Armenian Youth Camp confers no rights of ownership whatsoever. I release Armenian Youth Camp, its contractors and its employees from liability for any claims by me or any third party in connection with my participation or the participation of myself.
Armenian Youth Camp (supported by the Armenian Cultural Foundation), was established to create a fun and safe environment that embraces the Armenian culture, encourages independence and nurtures lifelong friendships. As an AYC Staff member, you are an integral part of making the Summer Camp experience fun, safe, and positively memorable. AYC maintains a zero-tolerance policy for illegal behaviors and any behaviors that endanger children. Armenian Youth Camp reserves the right to prosecute unlawful infractions and dismiss Armenian Youth Camp Staff members who violate the Code of Ethics and Conduct (“Code”) outlined here. Possession of any of the following items are strictly prohibited and are grounds for the immediate dismissal of any Armenian Youth Camp Staff member: • Alcohol: The possession, consumption or use of alcohol is not permitted on the campgrounds for any purpose at any time. Any staff member on camp property who is found to be under the influence of alcohol is subject to dismissal. • Marijuana, illegal drugs or controlled substances: The possession, consumption or use of illegal drugs is not permitted on the campgrounds for any purpose at any time. Any staff member on camp property who is found to possess or to be using illegal drugs is subject to dismissal. • Smoking: Armenian Youth Camp is a smoke-free environment. The smoking of cigarettes, cigars or any other substance on the campgrounds is prohibited. • Firearms, replica firearms, knives (including pocket knives) or any other weapons: Weapons of any kind are not permitted on Armenian Youth Camp grounds. Any found will be immediately confiscated and the owner will be subject to dismissal. • Fireworks, explosives or other flammable materials • Pornography: The possession or is not permitted on the campgrounds at any time. Any found will be immediately confiscated and the owner will be subject to dismissal. As an Armenian Youth Camp Staff member you serve as a role model to the children who encounter you; as such you should conduct yourself responsibly and behave accordingly. The following are behavior guidelines to follow while volunteering as an Armenian Youth Camp Staff member: • Fires are restricted to the campfire which can only be started by designated staff, and only in the designated campfire area. • Armenian Youth Camp Staff members are required to stay within campgrounds at all times. Any departure from the camp facility requires express permission from the Camp Director. • Armenian Youth Camp Staff members must be respectful and follow the direction and directives of the designated Director(s) during the Armenian Youth Camp session. • Armenian Youth Camp Staff members must comply with all applicable federal, state, and local jurisdiction laws, statutes, ordinances, rules and regulations during the Armenian Youth Camp session. • Language: Foul language in the presence of children will not be tolerated. • Harassment: Armenian Youth Camp has a zero tolerance for harassment of any type. Harassing behavior, including bullying, cursing or defaming remarks, to other Armenian Youth Camp staff members is unacceptable. Harassing behavior targeted to campers is grounds for immediate dismissal.
-I agree that failure to abide by any of the items specified within this Code may result in my dismissal from the staff position, expulsion from Armenian Youth Camp, and denial of future return to the Armenian Youth Camp . I have read, understand and agree to abide by all the above rules.
-I understand that I am volunteering to provide direct and/or indirect supervision of children and/or young adults attending the camp sessions. And in that position, I take responsibility over the health and well-being of each person assigned to my care, and will put their needs and interest first when making decisions. I understand that in an emergency situation it is my primary responsibility to secure the safety of each camper assigned to my care, and to assist in the security of other campers and staff.
-I will refrain from participating in any activities that are contradictory to or violate any of the rules as set forth by the Armenian Youth Camp Committee and Armenian Youth Camp Management Board. And in my position, I will enforce the rules to all campers.
-I will follow the enclosed Armenian Youth Camp Child Abuse Policy Guideline as it relates to relations with the campers.
This policy on child abuse was approved by the Armenian Youth Camp Committee and Armenian Youth Camp Management Board in order to help safeguard the health and well–being of all campers, counseling staff, program staff and directing staff participating in the Armenian Youth Camp. Personal Rights The Armenian Youth Camp Committee and Armenian Youth Camp Management Board endorses the following personal rights for all staff and campers. All staff and campers are entitled to: • Dignity in person relationships with staff and campers. • Safe and healthful accommodations, furnishing and equipment. • Freedom from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse or other actions of a punitive nature including but not limited to: interference with function of daily living including eating, sleeping or toileting; or withholding of shelter, clothing, medication or aids to physically functioning. • Not be locked in any room, building or center premises by day or night.
Prohibitions Inappropriate behavior or disciplinary measures, including but not limited to the following, shall be prohibited. • Corporal punishment, including hitting, spanking, beating, shaking, pinching, and other measures that produce physical pain. • Withdrawal or the threat of withdrawal of food, rest, or bathroom opportunities. • Abusive or profane language. • Any form of public or private humiliation, including threats of physical punishment. • Any form of sexual abuse • Any form of emotional abuse, including rejecting, terrorizing, ignoring, isolating, or corrupting a child. Any staff member must report any such known abuse immediately to the Armenian Youth Camp Director. Any staff member or camper engaging in such behavior faces dismissal by the Armenian Youth Camp Committee and Armenian Youth Camp Management Board.
Definition The following are descriptions of four major type of maltreatment, all of which are strictly prohibited: Physical abuse, neglect, sexual abuse, and emotional abuse. While state definitions may vary, operational definitions include, but are not limited to, the following: Physical Abuse Characterized by the infliction of physical injury as a result of punching, beating, kicking, biting, burning, shaking, or otherwise harming a child. The parent or caretaker may not have intended to hurt the child; rather the injury may have resulted from over-discipline or physical punishment. Child Neglect Characterized by failure to provide for the child’s basic needs. Neglect can be physical, education, or emotional. Sexual Abuse Includes fondling a child’s genitals, intercourse, incest, rape sodomy, exhibitionism, and commercial exploitation. Emotional Abuse (psychological/verbal abuse /mental injury) Includes acts or omission by the staff, or could cause serious behavioral, cognitive, emotional, or mental disorders. Examples include extreme or bizarre forms of punishment, such as confinement of a child in a dark closet, as well as less severe acts, such as habitual scapegoat, belittling, or rejecting treatment. 1. Derived from the State of California Regulations for Child Care Centers 2. Derived from policies outlined by the Nation Resource Center for Health and Safety in Child Care, located at the University of Colorado Health Sciences Center in Denver, Colorado, and funded by the Maternal and Child Health Bureau, U.S Department of Health and Human Services. 3. Derived from the definitions provided by the National Clearinghouse for Child Abuse and Neglect.
AFFIRMATION This document will go on file in your Armenian Youth Camp Staff file. It serves as proof that you have received and read the CHILD ABUSE POLICY GUIDELINE. I have read and understand the Armenian Youth Camp CHILD ABUSE POLICY GUIDELINE. I understand that I am volunteer subject to all Armenian Youth Camp rules and regulations. I am aware that violation of these rules may subject me to disciplinary action or dismissal as specified above.
I authorize investigation of all statements herein, including any checks of criminal records, and release the camp and all others from liability in connection with same. I further agree to adhere to all Armenian Youth Camp regulations and to abide by all of the decisions made by the Armenian Youth Camp Committee, Camp Director, and Management Board. I understand that untrue, misleading, or omitted information herein or in other documents by the applicant may result in dismissal, regardless of the time of discovery by the camp. I also understand that this application will be void should I not attend the mandatory counselor orientation at Camp Sylvester April 14-15, 2018. All applicants are subject to mandatory drug testing prior to being approved as a counselor. Once approved, all counselors are also subject to random drug testing during their stay at camp.
You represent and warrant that you are in sufficient physical condition to safely participate in the Armenian Youth Camp Event, and have no medical condition that would make your participation in the Event more hazardous. You consent to medical care and transportation in order to obtain treatment in the event of injury to you and understand that this Agreement and Waiver extends to any liability arising out of or in any way connected with the medical treatment and transportation provided in the event of an emergency and/or injury. You understand that no medical care may be available, but if it is, you assume liability for any and all medical expenses incurred as a result of your participation in the Event (where such medical expenses are not provided on a free of charge basis by any medical services organizations, clinics, or hospitals), including, but not limited to ambulance transport, hospital stays, physician, and pharmaceutical goods and services. You agree to observe and obey all posted rules and warnings, to follow any instructions or directions provided to you by the Event organizer and to abide by any decision of any Event official relative to your ability to safely participate in or attend the Event. You understand and agree that you are expected to exhibit appropriate behavior at all times while at the Event and to obey all applicable laws while participating in or attending the Event. This includes, generally, respect for other people, equipment, facilities or property. You agree that Event officials may dismiss you, without refund, should your behavior, in the opinion of the Event organizer, endanger the safety of or negatively affect the Event. You understand and agree that you are responsible for taking care of your own personal belongings during the Event and, to the maximum extent permitted by law, the Event organizer is not responsible for any personal item or property that is lost, damaged or stolen at the Event. You understand and agree that the Event organizer reserves the right to cancel the Event in the event of weather (including, but not limited to, heat, tornadoes, earthquakes, fires, storms, lightning and floods), accidents, acts of war or terrorism, military conflicts or riots, or for any reason that would affect the safety and security of Event participants and/or spectators or the feasibility of the Event to be held. In the event of such cancellation or any other cancellation for any reason, there will be no refund of your payment unless authorized and paid by the Event organizer.
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