Camp can be a transformative experience for young people. Thank you for volunteering to come to camp. We simply cannot operate without the help of our dedicated and committed adult staff and chaperones. Please complete this form so that we can best support you while you are at Ebersole. Thanks again.
Camp Code. This is a letter and number combination that is unique to your group. This code will be provided by the lead teacher or group leader. This is NOT a student ID number. The Camp Code will be two letters (usually the first two letters of your school), followed by the six digit date of arrival. For example, if students from Pattengill were arriving on October 8, 2023, their Camp Code would be PA100823.
Role with the visiting group:
Staff (LSD Employees)
Name of the School or Group you are attending with:
PART I: ADULT STAFF OR CHAPERONE'S INFORMATION
Part II: DIETARY INFORMATION
If the Ebersole Center is supplying your meals, please provide us with the following dietary information.
I have no known food allergies or intolerances.
I am allergic or intolerant of the following dietary items or ingredients.
I have other dietary restrictions (e.g., vegetarian, vegan, etc.).
Please share any relevant dietary information in the space below.
PART III: HEALTH INFORMATION
Note: As an adult staff member or chaperone you are not required to share any health history information with us, but we are required to ask. Please know that this information will remain confidential and will only be shared on a “need to know” basis with Ebersole staff members or other emergency first responders.
Do you have any health conditions such as a chronic condition or special health circumstance that we should be aware of or that would impact your ability to fully participate in camp activities?
No, I am fully prepared to participate in camp activities.
Yes, here is the information that you should be aware of:
Please share any relevant health information in the space below.
PART IV: EMERGENCY CONTACT INFORMATION
Emergency Contact's Last Name:
Emergency Contact's First Name:
Emergency Contact's Phone:
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