Rosenbaum PPB Youth Camp – Staff

Let's make sure you're applying for the right camp! Which camp are you completing this application for?*

Rosenbaum PPB Youth Camp @ Parkrose HS - June 24th - 28th
Camp Rosenbaum @ the Oregon Coast - July 20th - 26th

If you are applying for Camp Rosenbaum in July, please visit: https://www.camprosenbaum.org/staff/

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To complete the Camp Rosenbaum staff application, please visit www.camprosenbaum.org/staff.

Last Name*

First Name*

Middle Name*

Are you a sworn officer?*

Yes
No

Gender*

Male
Female
Non-binary/Transgender/Gender non-conforming

Last four of Social Security Number*

Date of Birth*

Email*

Affiliation

Your Agency*

Supervisor Name

Supervisor Phone

Supervisor Email

Do you have supervisor approval to attend Camp?

Contact Information

Home Address*

Street Address City State / Province / Region ZIP / Postal Code

Home Phone

Cell Phone*

Work Phone

Emergency Contact Name*

Emergency Contact Phone*

Emergency Contact Email

Camp Information

Have you been assigned as a head coach?*

Yes
No

Activity*

Please select your preferred activity. If you are open to assisting in other activities, please list your second and third preferences in the "Comments" section below.

Are you available all days of camp?*

Yes
No

If no, which days are you available?

Do you have any physical limitations that could impair your ability at Camp?*

Yes
No

If yes, please include description in comments section below.

T-Shirt Size (Unisex)*

Comments

Form Submission

TERMS AND CONDITIONS*

I agree
I do not agree (your application will be received but not accepted at this time)

I agree to the following terms and conditions. 1) I certify that all statements made by me on this application are true and correct to the best of my knowledge. I understand that any misrepresentation of facts can exclude my being considered for a volunteer position with Camp Rosenbaum, or after my service begins may be cause for release. 2) I understand that my involvement as a volunteer at Camp Rosenbaum is contingent upon a criminal history check. 3) I understand that my participation is strictly on a volunteer basis and that there will be no insurance provided against bodily harm. I agree to hold harmless the entity known as Camp Rosenbaum from liability for any and all bodily injury, sickness or property loss/damage sustained while serving as a volunteer. (Note: If you do not agree with any of the above terms and conditions, we will be unable to accept your application at this time. Your form submission will be received but will not be processed.)

Email

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Rosenbaum PPB Youth Camp – Staff

2024 Rosenbaum PPB Youth Camp – Staff Registration

Staff dates: June 24th – 28th, 2024

Registration will be open from February 1st – April 12th

PYC Staff Registration

Affiliation

Contact Information

Camp Information

Form Submission

Mailing Address:

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