The Valerie Fund's Camp Happy Times

Registration for New Counselors

The Valerie Fund's Camp Happy Times Counselor Application

2017 Dates: August 14th-20th Application Deadline: March 15th

Camp Happy Times Volunteer Information - Prospective Volunteer

Note: If you did attend CHT in 2017, please complete the Returning Counselor Application. Thank you!

Camp Happy Times counselors are all volunteers. Applicants for CHT positions are carefully screened each year prior to acceptance for that year’s camp session. Although we value the intentions and backgrounds of each volunteer applicant, positions are filled with the best candidates based on the needs of the camp and individual strengths and expertise.

Mission
Camp Happy Times promotes friendship, independence and a spirit of cooperation for pediatric cancer patients and survivors aged 5-21. Our philosophy is to provide a recreationally therapeutic environment that engages participants while building self-esteem, confidence, trust and friendship.

Volunteers
The role of the counselor is complex and demands emotional and physical stamina for a rigorously scheduled week. Counselors encourage the campers to take on the challenges of various daily activities at camp while ensuring their safety and comfort. A fully staffed infirmary addresses any medical issues or concerns during the week of camp.

Qualifications

Minimum age: 22
Physically, emotionally and cognitively capable of caring for children aged 5-21, who have or have had cancer, in a camp setting.
Cooperative, flexible, reliable and able to work well with others by using good communication practices.
Must commit to a full week overnight, which includes prompt arrival on the first day of camp

Monday, August 14th (by 10am) – Sunday, August 20th, 2017 (until 1pm)

Attendance at Staff Development Sunday, July 16, 2017 from 10am-4pm at the Westminster Hotel in Livingston, NJ. Attendance is mandatory for new volunteers and is required every other year for all volunteers.

Application Guidelines– Please read carefully

Applications interested in volunteering at The Valerie Fund’s Camp Happy Times 2017 must complete and return the application by March 15th, 2017.
Application must be accompanied by copies of valid photo identification and health insurance card front and back. The application is not complete without this information.
In addition, applicants must complete the screening procedure successfully, which includes an interview, background check, and speaking with one personal and one professional/educational reference.
Applications are good for one year. Online applications will be received automatically and there are no further steps required. If using paper application, return completed applications by the deadline to The Valerie Fund / CHT Office:

Camp Happy Times
2101 Millburn Avenue
Maplewood, NJ 07040
Fax to: 973-761-6792 Attn: Camp Happy Times
Scan and Email to: mruttler@thevaleriefund.org

Questions? Visit our website at www.thevaleriefund.org/camphappytimes or email us at mruttler@thevaleriefund.org

Personal and Medical Information

All medical information is maintained under the supervision of the Infirmary Medical Supervisor,
Camp Happy Times, and is protected by Federal Confidentiality Laws.

Please complete ALL current information on this page.

Application Form

Last Name* A value is required.

First Name* A value is required.

Gender*

Male Female Please make a selection.

Date of Birth* A value is required.

Age* A value is required.

Home Address* A value is required.

Apartment

City* A value is required.

State* A value is required.

Zip* A value is required.

Home Phone* A value is required.

Cell Phone* A value is required.

Email Address* A value is required.

Preferred Age Group of Campers (Preferences are not guaranteed)* Please select an item.

T-Shirt Size (Unisex)* Please select an item.

Pants Size* Please select an item.

Which is the best way to contact you?(Select One)* Please select an item.

What is your connection to Camp Happy Times/The Valerie Fund?

Have you ever been a

The role of a CHT volunteer is complex as it demands emotional and physical stamina for a rigorously scheduled week. Are you physically, emotionally and cognitively capable of caring for children, aged 5-21 who have or have had cancer, in a camp setting?*

Yes No Please make a selection.

1. Can you commit to attending volunteer orientation at the Westminster Hotel on Sunday, July 16th, 2017 from 10am – 4pm?*

Yes No Please make a selection.

2. Can you dedicate a week of your time for Camp Happy Times 2017 from Monday, August 14th – Sunday, August 20th*

Yes No Please make a selection.

Have you ever had the chickenpox (varicella)?*

Yes No Unknown Please make a selection.

Year of Chickenpox vaccination:

Have you had a tetanus vaccination? *

Yes No Unknown Please make a selection.

Year of Tetanus vaccination:

Have you ever had Measles vaccination (MMR)?*

Yes No Unknown Please make a selection.

Year of Measles vaccination:

Have you ever had your Flu vaccination? *

Yes No Unknown Please make a selection.

Year of Flu Vaccination:

I affirm that all information provided is accurate and true. I understand that any falsification of any information will immediately terminate my application and further opportunities with The Valerie Fund and Camp Happy Times.

I acknowledge that The Valerie Fund and Camp Happy Times will require a background check as a process for this application.

In the event of a medical or surgical emergency, I herby authorize the Licensed Medical Staff at Camp Happy Times to render to me or arrange for me to receive any and all treatment deemed advisable by them and to be rendered under the supervision of medical personnel. I also understand that I am responsible for any cost incurred for such treatment that any existing insurance may not cover.

Social Security Number* A value is required.

Driver's License Number* A value is required.

Driver's License State* A value is required.

Current Employer* A value is required.

Address of Employment* A value is required.

City* A value is required.

State* A value is required.

Zip* A value is required.

Current Position* A value is required.

Years of Employment* A value is required.

References

Full Name of Personal Reference* A value is required.

Relationship to Personal Reference* A value is required.

Personal Reference Home Number* A value is required.

Personal Reference Cell Number* A value is required.

Personal Reference Email* A value is required.

Full Name of Professional/Educational Reference* A value is required.

Professional/Educational Reference Title* A value is required.

Relationship to Professional/Educational Reference* A value is required.

Address of Professional/Educational Reference* A value is required.

Professional/Educational Reference Phone Number* A value is required.

Professional/Educational Reference Email* A value is required.

Medical Information

All medical information is maintained under the supervision of the Infirmary Medical Supervisor, Camp Happy Times, and is protected by Federal Confidentiality Laws.

Full Name of Emergency Contact* A value is required.

Relationship to Emergency Contact* A value is required.

Emergency Contact Home Number* A value is required.

Emergency Contact Cell Number* A value is required.

Emergency Contact Work Number* A value is required.

Primary Care Physician Name* A value is required.

Primary Care Physician Phone Number* A value is required.

Physician Address* A value is required.

Physician City* A value is required.

Physician State* A value is required.

Physician Zip* A value is required.

Name of Primary Medical Insurance Provider* A value is required.

Group Number* A value is required.

Policy Number* A value is required.

Insurance Phone Number* A value is required.

Address* A value is required.

City* A value is required.

State* A value is required.

Zip* A value is required.

Are you currently under the care of your physician for any medical condition or disorder?*

Yes No Please make a selection.

Please list any medical conditions since 2010

Surgeries / Reasons for Hospitalizations

Heart Disorder or Condition or Chest Pain?*

Yes No Please make a selection.

Back or Neck Injury?*

Yes No Please make a selection.

Cancer?(even as a child)*

Yes No Please make a selection.

High Blood Pressure?*

Yes No Please make a selection.

Other?

Please list any medication(s) you are currently taking:

Are you allergic to any medications?*

Yes No Please make a selection.

Please list the medications you are allergic to and the reaction you had below

Are you allergic to any food or substances?*

Yes No Please make a selection.

Please list the food(s) and substance(s) you are allergic to and the reaction you had below

Questionnaire

Please answer all of the following questions in details. Any questions not answered fully will delay the processing of this application.

How did you hear about Camp Happy Times?

Explain your experience with camping or camp environments.

Explain your experience working with children.

Explain prior volunteer positions that you have held and your specific responsibilities.

What motivates you to be a volunteer with children with cancer?

List any concerns, ideas, suggestions or questions.

Volunteer Terms Agreement

I agree to the Volunteer Terms Agreement* (read) Do you agree to the Volunteer Terms Agreement?

I agree to the Volunteer Conduct Guidelines* (read) Do you agree to the Volunteer Conduct Guidelines?

Digital Signature* You MUST sign and date your application.

Annual Hope & Healing Campaign

I would like to make a Tribute

Programs and Services

Registration for New Counselors