Diabetes Camp Volunteer Application

Please submit (1) This Application (2) Background Check to our office at 101 Robeson Street Suite 410 Fayetteville, NC 28301 either in-person or online. Or you can submit by fax to 910-321-6254. Call with questions 910-615-1885.

Name*

Date*

Date

Email address*

example@example.com

Phone*

Professional titles if applicable

Have you volunteered at a diabetes camp before?*

YesNo

If yes in what capacity*

How would you like to be involved? You may check more than one. We will do our best to assign you to your selected category but please be flexible as we may need your assistance elsewhere!*

Counselor/Co-counselor *must commit to staying overnight and attending our brief counselor meeting prior to Diabetes CampArts and CraftsSports & Field ActivitiesEducational Games counselor meeting prior to Diabetes CampFood Prep/Serving

Which day(s) are you available to volunteer? If you did not select Counselor/Co-counselor, please select the dates:*

Thursday, June 19, 3pm – 7pmFriday, June 20, 8am – 5pmSaturday, June 21, 8am – 5pmSunday, June 22, 8am – 12pmIf you selected Counselor or Co-counselor, please plan to attend every day and overnight. If you cannot attend all days, please state your availability below:

Please list the name and contact information for two references, at least one of which has knowledge of your participation as a volunteer:

1*

2*

MUST SUBMIT BACKGROUND CHECK and WAIVER FORMS WITH THIS APPLICATION. YOUR

APPLICATION WILL NOT BE ACCEPTED WITHOUT ALL FORMS!