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 (Note: 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.):
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:
Security Check - To verify you are not a robot, please answer this question:
(fetching question...) CAPTCHA image
Get a different question