Adult On-Line Application
Camps Gilbert Run, and Gilbert Run Teen

After pushing the "Submit" button you will receive a "Form Confirmation" page.  
If you don't get the confirmation, we didn't get your input!

First Name:
Middle Initial:
Last Name:
E-Mail: (choose one you check often)
Street/PO Box:
City:  
State:

  

Zip Code: 

  
Day Phone: (999-999-9999)
Eve Phone: (999-999-9999)
Cell Phone: (999-999-9999)
Your camp nickname:   (examples:  Peaches, Chipmunk, Tink, etc.)
Camp Requested:    (If you help at more than 1 camp, hit the back button after you submit. Then change camp data in green box, and update any special certs needed, bus stop, etc, and resubmit.  Only 1 health form is needed and will be used for all camps.)
Teen Ropes course trip only ($25) submit check to Director if not first aider or child/adult ratio
   

What is your availability for Camp?                    
 If part-time, for what hours/days/field trip/overnight times are you available? 

Note: Junior and Teen units have an overnight at Camp Aquasco on June 27, Wed.
Unit responsibilities   Center responsibilities All Camp jobs
Assignment Preference 1st Choice  
Assignment Preference 2nd Choice  
Assignment Preference 3rd Choice  

note:

  if any center, list your interests, expertise areas
Other area List:      
** Required certification for archery, canoe, kayak, lifeguard, WSI, and first aider--Send Certification copy to Camp Director**
If signing up for a camp requiring release/waivers forms (kayaking, rafting, tubing, horse, ropes), mail/Fax to Director. Release forms are found on main registration page. If you are assigned to a unit/group that travels/spends the night, you will be expected to go with girls.
 
If you choose a camp center, I prefer to have someone helping me, if available:
Teen Aide   Another Adult    Either   None
 
T-shirt size:  You must help 3-5 days to receive a free T-shirt   T-shirt size chart
Extra T-shirt (include $8)
 
I am a registered Adult Girl Scout.      Troop # (required if registered)
                with Association/Service Unit:   (ex.10-3, 10-12, 21-5) 
I am Not currently registered as an Adult Girl Scout
I have completed the Council one-time Volunteer Application.  If no, or unsure, check out http://www.gscnc.org/ .
 
Council requests camps to list data on reports for statistical purposes.  This does not affect your volunteer status or availability.  
Racial Breakdown:    
Ethnic Origin:  Not Hispanic or Latino     Hispanic or Latino
Swimming ability (required for aquatic activities only):  
 none    Level 1    Level 2    Level 3   Level 4   Level 5   Level 6    Red Cross Skill Levels
Transportation for this camp::             
Not all stops for all camps. Pre-schoolers can not ride bus without parent on bus. There are no special seats for young children on the bus; we use school buses.    All stops must have 6 or more to stop and an adult must ride bus from route beginning, or route may change.
There must be 10+ to make stop happen.  Exact stops and routes are determined by current registration
Yes  No   I'm willing to be a Bus Stop Monitor at the bus stop (do not have to ride bus).
Yes  No   If riding bus, I'm willing to be a Bus Chaperone on the bus ride to and from camp.
 
Yes  No   I am an Adult Buddy. (must be 18 to be an adult buddy) Do not put child's name unless over 18.
If yes, my Adult Buddy's name is: (You do not have to be in same unit or area)
(Applies to camp only, not teen trek)

List your children who would accompany you at camp.  Register each person separately on the council day camp registration pages, including boys and pre-schoolers.

 

Child's Name

 Camp Program
1
2
3
4

5

I prefer to be with one daughter/son at camp:  No  Doesn't matter Yes   
  If yes, give child's name:
 
Identify GSCNC Girl Scout training you have completed: (Applies to camp only, not teen trek)
100A Intro to Girl Scouting for Resource Volunteers 150 Working with Teens
100B Fundamentals for Resource Volunteers 151 Silver Awards
101 Basic Leadership Training (002) 152 Gold Awards
102 Daisy Program 110 Troop Trip Travel
103 Brownie Program 200/224 Cookout and Campout
104 Junior Program 250 Lightweight Camping 
350 Program Aide Instructor 260 Back Country Camping
Day Camp   No training
 
These courses have certifications and expiration dates -- we're only interested in current certifications as of time of camp.  Provide the date that your certification expires. Send a copy of your certificate/card to the Director.

Course Completed

 Cert Expiration  
Level 1 First Aid   Level 2 First Aid
Adult CPR  
Child/Pediatric CPR  
Physician, physician's assistant, nurse, practical nurse, paramedic, or EMT.  
Archery Instructor
Canoe Instructor
Lifeguard-Open Water
Lifeguard-Pool
Water Safety Instructor
 
(Questions below apply to camp only, not teen trek)
DO NOT USE [ENTER] OR [RETURN] KEY IN TEXT ANSWERS BELOW!  If done, this action will create 2 records, one without a name. ACTION WILL CORRUPT BOTH RECORDS and you will not be registered.
 
Do you have any plans for completing any training before camp?  If so please describe.  For example, "Registered to take 200 on March 19". OR First Aide on April 1.
 
List the Adult Girl Scout positions you have held within the last five years and include the number of years you've held them.  If you have previous GSCNC summer camp experience, please provide the name of the camp and the year.  For example: "Brownie Leader-3" means you were a Brownie Leader for 3 years. Or "Winona 1-2004, 2006, 2007."
 
If you have medical or physical concerns that would affect your placement at camp, please describe them.  We will work with you to accommodate your special needs to the best of our ability.
 
If you have special skills or knowledge that would be beneficial at camp, please describe.
  Any other comments?
I have carefully read the information provided above and/or on the Camp web page about volunteer opportunities. Once accepted I will be required to sign a volunteer appointment agreement.  If at any time I fail to meet my commitment, my daughter/s will be involuntarily withdrawn from Camp and placed as space becomes available with additional camp fees due, same as for regular campers.  I will fill out the Adult Health History Form and submit to camp.  The health form is required for all persons on camp property, per GSCNC and MD State Health Dept.
   
Signature (//name//)
NOTE: you must fill out the Health History form also (link on page after submit).

Camp Home    Registration

Revised: 01/15/12 12:24