Camp Waves of Hope

Big Buddy Application

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Camp Waves of Hope will be Sunday, August 18^th - Wednesday, August 21^st, 2024 for Big Buddies.

Please include a recent photo with your application and email a picture as an attachment
to ashleylawtonics@gmail.com.
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You will be contacted in the beginning of August with further information.

Email AddressFirst NameMILast NamePreferred NameAgeBirth DateGenderAddressCityStateZip CodeHome PhoneWork Phone
OccupationEmployerEmployer Address What is your Adult T-Shirt Size?SmallMediumLargeXLXXLEducation: Note--Selection of volunteers is not based on education/licensesProfessional Licenses and/or Certifications:CPR/First Aid Certification Expiration DateLifeguard CertificationWhat Experience Have You Had Working With Children?What Camping/Outdoor Experience(s) Have You Participated In?What Are Your Hobbies?What Are Your Favorite Camp Foods/Snacks?Bereavement History: Your Relationship To DeceasedYear of Your Loved One's Age?Age At Loss?Cause Of Death Please Explain How You Grieve?Have you received any professional support (i.e. school counselor, peer support group, psychologist, psychiatrist, pastoral counselor, social worker or mental health counselor)?YesNoIf yes, is support currently being provided?YesNoIf counseling is no longer in progress, how long was the period of support provided?How have you been coping with the pandemic and all the challenges that have come along with it?What are your areas of interest for volunteering:Healing Circle FacilitatorFun Time Facilitator”Big Buddy” in Training (12 to 14)“Big Buddy”Do you have any dietary restrictions?Gluten freeLactose freeVegetarianNut allergiesReferences: Name and RelationshipPlease provide a 100 word (or less) statement about why you want to be a Big Buddy. Health History FormFirst NameMILast NameAddressCityStateZipBirthdateAgeGenderEmergency Contact Address of Emergency ContactRelationship to Emergency ContactPhone Number of Emergency ContactHealth History (Check Those That Apply):Allergies (Food/Animals/Bee Stings)Constipation/Diarrhea Diabetes DepressionFaintingHearing Impairment Menstrual CrampsNightmaresHay FeverWears Contact Lenses/GlassesAsthmaConvulsions/SeizuresEmotional ProblemsAnxiety DisorderSevere Reaction to Poison IvyHeart DiseaseHepatitisKidney DiseaseFrequent Ear InfectionsBleeding/Clotting DisorderOtherPlease explain any "yes" answers to the above health history check. Indicate any information useful to any of these health conditions.Covid Vaccine (Not mandatory to attend camp):Tetanus ShotTuberculin TestDate of your last health examination?Were any complicating medical problems noted?Since your last health exam, have you had any of the following:A serious injury requiring medical attention:A surgical operation or fractureMedication prescribed to be taken on a regular basis:Inpatient or emergency room treatment in a Hospital:Please explain any "yes" answers to the above. Include datesMedications/Treatments Please include all prescribed and over the counter medications.Medications/Treatments Please include all prescribed and over the counter medications.Should a medical emergency arise during my participation in a Camp Waves of Hope activity and I am unable to speak for myself, I consent to:

The administration of medical treatment and/ or surgical procedures deemed necessary by the medical doctor and/ or medical facility identified below or chosen by the Camp Waves of Hope director, and The immediate administration of life-sustaining measure deemed necessary under the circumstances.Signature and Date Does your child have permission to self-administer sunscreen and bug spray at Camp Waves?Health Insurance InformationCompanyPolicy NumberPolicyholder's NameDoctor's NamePhone Number

Statement of Confidentiality
‍I understand that information regarding Camp Waves of Hope campers, their families, staff and any persons receiving support or services in any capacity is privileged information for use by and with authorized person(s) only.

I will disclose such information only in the discharge of my assigned duties and responsibilities with Camp Waves of Hope or person(s) authorized to receive such information through the signed consent of camper, parent, family member or affected party.

I will not disclose any information with anyone unauthorized to receive this information. I will handle any and all paperwork and forms with proper procedure of control so that no information is accidentally observed or released to any unauthorized person(s). I also understand that the casual sharing of camper/camper families/staff information in public places or settings is inappropriate.

I have read and understood the preceding statement on Confidentiality and agree to abide by it.

Print Name Signature

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Friends ‍‍‍Mailing Address‍‍‍

Friends of Hospice in Oswego County
P.O. Box 102
Oswego, NY 13126
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Friends Office Address

3 Creamery Rd
Oswego, NY 13126

Friends of Hospice

Elena Twiss
Executive Director
Phone: 315-216-7580