Personal Information (please fill out completely)

Volunteer's Name	Gender male female
Maiden name or other alias (if applicable)	Age at time of retreat/camp
Date of birth	Social security number
Drivers license number	State

Address	Apt. #
City	State
Zip
Home phone	Cell
Email address	Work phone

Occupation

Employer

Health

1) Will you be bringing medications to the retreat/camp? yes no

2) If yes, do any of your medications require refrigeration? yes no

3) Date of last tetanus shot:

Red Ribbon Trails recommends that all attendees have had a tetanus shot within the last 10 years or receive a booster before attending a Red Ribbon Trails event.

4) Date of last TB Test:

Test results (please check one) positive negative (TB Tests are recommend but not required.)

Red Ribbon Trails recommends all attendees to have been tested for TB within the last year.  Those who have tested positive for TB in the past must provide a letter, (dated within the last year), from their physician advising of their TB status and their ability to attend and/or work at a retreat/camp with immune comprised attendees, including HIV+ persons, to attend Red Ribbon Trails events.

Emergency contact information

Emergency contact name

Address	Apt. #
City	State Zip
Daytime phone	Evening phone

Volunteer experience

Organization #1	From	To
Supervised by	Phone	Extension
Roles, duties and responsibilities

Organization #2	From	To
Supervised by	Phone	Extension
Roles, duties and responsibilities

Organization #3	From	To
Supervised by	Phone	Extension
Roles, duties and responsibilities

Experience and/or training for working with youth

Organization #1	From	To
Supervised by	Phone	Extension
Roles, duties and responsibilities

Organization #2	From	To
Supervised by	Phone	Extension
Roles, duties and responsibilities

Organization #3	From	To
Supervised by	Phone	Extension
Roles, duties and responsibilities

Experience and/or training for working with persons with HIV/AIDS

Organization #1	From	To
Supervised by	Phone	Extension
Roles, duties and responsibilities

Organization #2	From	To
Supervised by	Phone	Extension
Roles, duties and responsibilities

Organization #3	From	To
Supervised by	Phone	Extension
Roles, duties and responsibilities

References: Persons not related to you who have knowledge of your qualifications

Reference name

Address	Apt. #
City	State Zip
Daytime phone	Evening phone

Reference name

Address	Apt. #
City	State Zip
Daytime phone	Evening phone

Reference name

Address	Apt. #
City	State Zip
Daytime phone	Evening phone

Interests and experience

Please list any specific interests/talents you would like to share with campers.

Would you be willing to lead an activity? yes no
If YES, what activity?

---

Check all areas of interest below

Physical activities

swimming
sports
camp games
Do you have experience in any of these sports? If so, which?

Are you currently a certified lifeguard? yes no

Musical activities

instrument playing
leading songs
Do you play any musical instruments? If so, which?

Photography

digital photography
film photography
Are you familiar with printing digital photos? yes no

If yes, are you Macintosh proficient? yes no

Creative activities

arts and crafts
face painting
story telling

Do you have any specialties?

Therapeutic activities

mental health therapy
art therapy

Please list specific training and certifiation

Age groups: Indicate age group(s) with which you have most experience or prefer to work.

2-4
5-9
10-12
13-17