Volunteer Application

DYS Hot Shots Camp is currently accepting applicants to fill available volunteer positions.

To ensure proper consideration, please fill in the information below as completely and accurately as possible.

Nutritional Information

Do you have any allergies? *

Education and License Information

Has your license ever been revoked?
Have you ever been accused of, convicted of, or had deferred adjudication of medical malpractice? *
Do you have malpractice insurance covering your service at camp?

Availability

Which camps are you interested in attending? *
Have you attended Hot Shots Camp previously as staff? *

Current Employment

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References

Reference 1

Reference 2

Reference 3

Additional Information

Do you have type 1 diabetes? *
Have you ever been convicted of a felony? *
DYS is looking into offering COVID-19 vaccinations to those who are attending camp this summer. We understand not every person wants or is medically qualified to receive a vaccine. If you are willing and able to receive the vaccine, please indicate below. *

Liability Waiver

The above information is true to the best of my knowledge. I authorize investigation of all statements herein and release Diabetes Youth Serives and all others from liability in connection with same. I understand that if employed, I will be an at-will employee. I understand that untrue, misleading, omitted information herein may result in dismissal, regardless of the time of discovery by Diabetes Youth Services

Waiver: In consideration of Diabetes Youth Services permitting me to participate at Diabetes Youth Services Camp, and acknowledging that activities while at camp have inherent risks, on behalf of my heirs, executors, adminstrators and assigns, I hereby waive, discharge, and release any and all rights claims for damages, losses or expenses which I may have against Diabetes Youth Service, Recreation Unlimited, Sylvania Park District/Olander Park, ProMedica Farms, or any other camp facility and their management, as well as any other person connected with Diabetes Youth Services Camps or as a result thereof. I hereby give Diabetes Youth Services, their legal representatives or assigns and those acting under their permission and upon their authority, permission to use my picture, and if desired, my name in advertising and in all forms of publicity, without limit as to time. I further release Diabetes Youth Services from any liability for what I might deem misrepresentation of be by virtue of alterations, optical illusions or faulty mechanical reproduction in such advertising and/or publicity.

 I further acknowledge that while Recreation Unlimited, Olander Park, and ProMedica Farms have COVID-19 protocols in place, and while DYS staff and volunteers also will be asked to follow COVID-19 protocols, DYS cannot guarantee that I will not contract COVID-19 while at a DYS camp or during registration and transportation to and from camp, and that there is an inherent risk of contracting COVID-19 by attending camp, and I hereby waive any liability against DYS for the same.

If you have any questions please contact:

Cindy Presser
DYS Program Director
419-291-1238
cindy@dys4kids.org

Please sign *
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A background check and drug screen are mandatory to be considered a a camp staff member. Upon acceptance of application, you will be given further instructions to complete the background check and drug screen.

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