General Information

To be a camp counselor, you must be at least 16 years old for Little Shots, 18 for Middle Shots, and 21 years old for Big Shots.
 
Please fill out all information to the best if your knowledge.
 +

Nutritional Information

Do you have Celiac disease/gluten intolerance? *
Do you have any allergies? *
0/150 characters

Education Information

Availability

Which camps are you available? *
Have you attended Hot Shots Camp in the past? *

Current Employer

Interview Availability & References

To better get to know potential camp staff, DYS will be conducting short interviews over Zoom/phone. Please select below the best days of the week where you will be available to speak with the Camp Director. *
Of the days of week chosen, what time of the day works best? Select all that apply. Note: The Camp Director will contact you to confirm a date/time before scheduling a meeting. *
Reference #1
Reference #2
Reference #3

Additional Items

Do you have type 1 diabetes? *
DYS is looking into offering COVID-19 vaccinations to those staff 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. *
Have you ever been convicted of a felony? *
0/500 characters

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

 *
clear

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.

Powered byFormsiteReport abuse