TK Camp Counselor Application - AMITA Health



AMITA Health St Thomas Hospice

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Tommy’s Kids Bereavement Summer Camp

Volunteer Application

Date________

First Name___________________________ Last Name__________________________

Street Address___________________________________________________________

City_____________________________________ Zip Code_______________________

Home/Work Phone_____________________ Cell Phone_________________________

Email___________________________________________________________________

Please answer the following questions:

1. Why would you like to volunteer at Tommy’s Kids Summer Camp?

2. Do you have experience working directly with children or in other related fields? (Camps, groups, etc.)

3. Have you ever lost anyone close to you due to death? When? Please explain.

4. Please list a few of your interests/hobbies:

Please provide the name and contact information of one reference (non-family member) that we may contact.

First Name___________________________ Last Name__________________________

Relationship to you_______________________________________________________

Phone__________________________________________________________________

Email___________________________________________________________________

Please sign below indicating your decision to become a volunteer for Adventist St. Thomas Hospice’s Tommy’s Kids Summer Camp. By doing so, you agree to abide by all policies and standards set forth by Adventist St. Thomas Hospice and their accrediting bodies. Submission of this application does not guarantee a volunteer position.

Signature___________________________________________ Date________________

Print Name______________________________________________________________

A representative from Adventist St. Thomas Hospice will contact you to arrange an interview upon receipt of your application. For questions please contact Laura Cottrell at 630.856.6985 or Laura.cottrell@

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