Sonoma Day Camp Adult Registration Form
Girl Scouts of Northern California – Sonoma Service Unit #103SONOMA DAY CAMPADULT VOLUNTEER REGISTRATION FORMRequirements:Sonoma Day Camp is 100% volunteer run. Rewards: Helping provide wonderful experiences for children.Learning new skills, making new friends, creating lastingmemories.Partial camper fee refund for full-time trained staff. All adultswho volunteer and work at camp will be given a 20* refundafter camp, per full day worked. A maximum of 100 will berefunded to each adult who is able to work the full week.*Please note in order to qualify for this rebate – the adultMUST attend required trainings. Full camp fees must be paidin full for your camper(s) ahead of time and refund check willbe cut within 4-6 weeks after camp is over to compensate youfor your time worked/volunteered.SEND COMPLETED REGISTRATION TO: Registered Girl Scout Adult with Background/Security Checkon file at the Council OfficeAttend adult Training Sessions: See website for specific dates/full calendar.MANDETORY ALL STAFF HEALTH & SAFETY TRAINING on theSaturday before camp starts***EVERYONE ASSISTING AT DAY CAMP MUST ATTEND THISALL-DAY TRAINING (9:00 AM TO 4:00 PM) NO EXCEPTIONS.EXCEPTIONSDay care can be provided if necessary – but priorarrangements would need to be made.A COMPLETE REGISTRATION INCLUDES:ADULT VOLUNTEER REGISTRATION FORMPHOTO (FACE) – 4x6 PrintADULT HEALTH HISTORY FORMVOLUNTEER SERVICE AGREEMENTBE A REGISTERED ADULTADULT GIRL SCOUT ( 15)( 15)BACKGROUND SECURITY CHECK ON FILE w/ COUNCILSonoma Girl Scout Day CampATTN: DAY CAMP REGISTRARP.O. Box 299El Verano, CA 95433A D U L T V O L U N T E E R I N F O R M A T I O N (PL E A S E F I L L O U T CO M PL E T E L Y )Name:Camp Name:Birthday:A ddress:Cell Phone:Phone:E- mail:Name of your Camper(s) attendingttending with you:you:Are you a registered Girl Scout?YesNoHave you completed the GSNC Security Clearance?Adult Volunteers get a fun patch and one free T-shirt (choose one):SmMedLrgX-LrgYesNoXX-LrgndONE (1) Camp T-shirt is our gift to you for volunteering. But many volunteers request a 2 shirt to help with laundry duties during the week.ndPlease let us know if you would like a 2 shirt ordered for an additional 10 fee (add this 10 to your campers fee).ndYes, please order me a 2 t-shirt for 10 extra. I have included an additional 10 with my campers registration.H OW I WOU LD L IKE T O H E LP – Pl e ase c he ck al l th e a p pro pri at e s pa ces. T h an k yo u!FULL TIME UNIT VOLUNTEER - ALL 5 Days! (Monday-Friday 8:30am-4:30-pm) – **Adult volunteers will most likely be assigned to aunit that their children are NOT in to allow for Girl Scout Independence. Equal to 20* refund per day worked per adult. As a full-timevolunteer, I will need to also register pixie and/or boy.PART TIME VOLUNTEER (Days are from 8:30am to 4:30pm) – Equal to 20* refund per day worked per adult. Min 2-Days!MondayTuesdayWednesdayThursdayFridayDays I am available (at least two):SPECIAL SKILLS: I am can assist in one of the following: (Days are from 8:30am to 4:30pm)Assistant NurseFloating Adult Unit VolunteerArcheryCamp Set-up (Sat & Sun before)Other: (admin skills, fundraising, camp prep skills, etc TBD)MondayTuesdayWednesdayThursdayFridayDays I am available:Camp Clean-up (Fri & Sat afterMy Areas of Expertise (craft, games,games, skills, etc) are:are:Prior/Other Girl Scout Experience and/or certifications:*Please notenote in order to qualify for 20 a day back rebate – you MUST attend required trainings.*trainings. *
Girl Scouts of Northern California – Sonoma Service Unit #103SONOMA DAY CAMPVOLUNTEER PHOTOSonoma Day Camp requires that a photo of each volunteer be included with the registration. You can staple it to this page. We willbeautifulful face.gladly accept any kind of photos as long as it is CURRENT and depicts a clear shot of your beautiVOLUNTEER NAME:
Girl Scouts of Northern CaliforniaAdult Health HistoryGirl Scouts of Northern California with offices in: Chico,Eureka, Alameda, Red Bluff, Redding, San Jose, SantaRosa, & UkiahT (800) 447 4475F (510) 633 7925www.GirlScoutsNorCal.orgPart 1: Adult informationAdult Name:FemaleBirth Date:Address/City/Zip:MaleEmail:Day Phone:Evening Phone:Cell Phone:Health Information Privacy StatementThe Adult Health History Record is for health care concerns at the specified event only. All records will be handled by staff/volunteers whose job includes processingor using this information for the benefit of the participant. All medical records will be held in limited access by the health care supervisor of the specific event.Minimal necessary information may be shared with event staff/volunteers in order to provide adequate participant safety and health care. The health history recordwill be retained by the council or GSUSA until it is destroyed. All forms/records with noted treatment will be retained for seven years. Access to the information willbe limited, but copies may be requested from the council by the participant or their legal representative.I have read the above procedures for handling the health history record information and I agree to the release of any records necessary for treatment, referral, billing,or insurance purposes.Adult Participant Signature:Date:Part 2: Insurance InformationName of Dentist:Phone #:Name of Doctor:Phone #:Insurance Carrier Name:Policy/Group Number:Part 3: Allergies/Illnesses/InjuriesAllergic Reactions: (Check those that Apply and specify nature of the allergic reaction)AnimalsHay FeverFoodInsect stingsMedicines/DrugsPlantsCheck here for no known allergiesPollenOther (specify)Chronic or Recurring Illnesses: (Check those that apply and give appropriate dates)ArthritisAsthmaHeart Defect/DiseaseBleeding/Clotting DisordersHypertensionMenstrual ProblemsDate of last health examination:If yes please explain:DiabetesDizzinessEar InfectionFaintingMusculoskeletal DisorderSeizuresWere any complicating medical problems noted?YesNoOther health conditions or injuries that might impact your participation?Part 4: MedicationPart 5: Consent to TreatIn the event of an emergency, every effort will be made to contact an emergencycontact. I hereby give authorization to the Girl Scouts of Northern California toseek treatment for myself by a licensed physician pursuant to California FamilyCode Section 6910 and California Civil Code 25.8. I know of no reason(s), otherthan the information indicated on this form, why I should not participate inprescribed activities.Are you taking any medications?YesNoIf YES, list medication, reason, and possible side effectsMedicationPossible Side EffectsAdult Participant Signature:Date:Part 6: Emergency Contact(s)NameRelationshipCell PhonePlease review the information on this form annually. If there are no changes orjust minor adjustments, please mark those, then sign and date this form whereindicatedForms Bank Adult Health Form 5/13/2013Day PhoneEvening te:
Adult MembershipService UnitJoin the global network of 3.2 million Girl ScoutsMembership Year through 9/30/20TroopCheck one:! New MemberCONTACT INFORMATIONTitle or salutation:! Renewing Member! Mrs.! Ms.Name: First! Miss! Lifetime Member! Mr.! Dr.MEMBERSHIP OPTIONS:GSUSA ID (if known)Annual Membership! Annual fee: 15! Other:MiddleLifetime Membership(including permanent membershipcard and recognition certificate)LastAddressApartmentCityState()Home Phone()Business Phone()Cell PhoneE-mail AddressEmployerTitle/Occupation! One time fee of 375:Adults 18 years of age or olderZip CodeI wish to opt in: ! Texts ! E-mailsDEMOGRAPHICSGirl Scouts respects and welcomes people from all backgrounds and abilities. By completing the following information (as defined by the USCensus), you ensure support and funding for girls in your community. Hispanic/Latina is defined as an ethnicity, not a race, therefore reportedseparately. This information is used for statistical purposes only.Gender:! Female! Male# of years in Girl Scouting:as a girl:as an adult:Date of birth://mmddHighest education: (check one)! Some High School! High School! Some College! Associate Degree! Bachelor Degree! Postgraduate DegreeI am: (check all that apply)! American Indian or Alaskan Native! Asian! Black or African American! Hawaiian or Pacific Islander! White! Other (please specify)I am Hispanic or Latina:! Yes! No! I choose not to shareat this timeACCEPTANCEGET INVOLVEDPARTICIPATION! I choose not to share at this timeI will be participating in Girl Scouting as: (check all that apply)! Volunteer—I am/will be volunteering for Girl Scouts! Parent/Family—I am a parent/guardian/family member of a Girl Scout! Girl Scout Alumnae—I was a Girl Scout, either as a girl, adult or bothAs a volunteer, I would like to participate in the following role(s):! 01—Advisor or Leader for a Group/Troop #! 02—Assistant Advisor or Leader for a Group/Troop Advisor/Leader! 03—Support Volunteer for a Group/Troop! 11—Service Team or Unit Volunteer! 12—Learning Facilitator! Other (specify)yyyyAge range:! 18-29! 50 and up! 30-49Household income:! 0– 14,999! 15,000– 34,999! 35,000– 49,999! 50,000– 74,999! 75,000– 99,999! 100,000 or more! I choose not to shareat this time! 150! 25Annual Membership: Lifetime Membership: ! Community Partner! Staff—I am/will be employed by Girl Scouts! OtherDonation: Total Attached: Representing Group(s)/Troop(s)/Service Unit Numbers:#########SUSUSU!!!!Cash ! Check*Amex ! DiscoverVisa! MasterCardOtherName on Credit Card! Camp: Help girls connect with nature during day orovernight camp.! Events: Share your passions during half or full day events.! Series: Share your interests in a way that fits your schedule! Travel: Expand girls’ horizons. Travel with girls across townor around the world!! Troop: Inspire and develop a group of girls on a regular basis.! Virtual: Interact virtually with Girl Scouts everywhere.! Administrative: Manage, support and recognize volunteers inyour community! Council Committees: Assist in council-wide Girl Scoutsoperations! Learning Facilitator: Coordinate learning opportunities! Fund Development: Promote and advance the Girl Scoutmovement through family and corporate donations! I wish to opt out at this time.YES! I would also like to make adonation today that directlybenefits girls in our area. Enclosedis my tax-deductible donationin the amount of: (check one)PAYMENT INFORMATION:GET INVOLVED “BEHIND-THE-SCENES”: (check all that interest you)The Girl Scout LawI will do my best to behonest and fair,friendly and helpful,considerate and caring,courageous and strong, andresponsible for what I say and do,and torespect myself and others,respect authority,use resources wisely,make the world a better place, andbe a sister to every Girl Scout.! One time fee of 195:Girl Scout Ambassadorsgraduating from High Schoolin this membership year in themonth of:(please submit by Sept. 1st ofgraduating year)! 500 ! 250! 100! 50! Other: PARTICIPATE WITH GIRLS DIRECTLY: (check all that interest you)Media PermissionWhen participating in Girl Scoutactivities I may be photographedfor print, videotaped, or electronicallyimaged. Images may be used inpromotional materials, news releases,and other published formats for eitherthe local Girl Scout Councils or GirlScouts of the USA. The images will bethe sole property of either the local GirlScout Council or Girl Scouts of the USA.GIRL SCOUT MISSIONGirl Scouting builds girls of courage,confidence, and character, whomake the world a better place.Credit Card #Expiration DateSignatureDateThe Girl Scout PromiseOn my honor, I will try:To serve God and my country,To help people at all times,And to live by the Girl Scout Law.*Make checks payable to Girl ScoutsTHANK YOU FORSUPPORTING GIRL SCOUTS!When making the GS Promise, individual members maysubstitute wording appropriate to their own spiritualbeliefs for the word “God.”Learn more about Girl Scouts atwww.girlscouts.org.I accept and abide by the Girl Scout Promise and Law:ADMIN USE ONLY:SignatureCouncil Code:DateService Unit/Team:Group/Troop:Return this registration form, along with GSUSA annual membership fee or applicable Lifetime fee to your local council. Fees are non-refundable or transferable to another person.
Girl Scouts of Northern California1310 South Bascom AveSan Jose, CA 95128VOLUNTEER SERVICES AGREEMENTName:Present Address: Phone: (NumberStreet)Apt. #CityStateZipDriver’s License Number: State Exp. Date:Birthdate:I offer my services to the Girl Scouts of Northern California as a volunteer and understand that I will receiveno monetary compensation for my work.I agree to fulfill the responsibilities assigned to me and to abide by any Council policies or regulations thataffect those responsibilities.Conditions: (See Job Descriptions for your specific volunteer assignment)Training is a required part of your staffing obligation. This is accomplished by 18 hours of combinedin-town, online and on-site pre-camp training. Training dates are:April 2nd, Thursday 7pm-9pm (Location TBD) – Mandatory for new volunteersApril 23rd, Thursday 7pm-9pm (Location TBD)May 15th, Friday 7-9pm (Location TBD)June 13th (Saturday) 9am-3pm, Camp Site at Dunbar Elementary – Mandatory for all volunteers.Additional training opportunities (see attached page) are available to accomplish the 18 hour requirement. Please discuss yourindividualized plan with Camp Staff if you are not able to attend some of the training dates.I understand that I am not considered an employee or agent of Girl Scouts of Northern California, and am notentitled to Sick Leave, Vacation, Health and Welfare Benefits, Retirement Benefits, or any other leave orbenefit established by State Law or Board Policy for employees of Girl Scouts of Northern California.I understand that, in the event of a situation which renders it appropriate to do so, either the Girl Scouts ofNorthern California or I may cancel this agreement.Camp: Sonoma Girl Scout Day CampDates: June 15-19th, 2015Assigned Position:Volunteer’s SignatureDateCouncil Representative’s/ Camp Director SignatureDate
Volunteer Training Information SheetSonoma Day CampName:& &&&&Camp&Nickname: &Name of Training&Location/VerificationPlease provide dates of completionand where training was taken&1 hour&&½ hour&&&&&&Outing, Short Trips and Overnights1 hour(must have taken within last 3 years)&&Troop Camping Certification4 hours(must have taken within last 3 years)Health and Safety4 hours(current First Aid/CPR training)&&&&Girl Scouting 101 and Becoming aVolunteer in GSNorCal(must have taken within past 3 years)Safety Wise(must have taken within past 3 years)The Girl Scout Program(must have taken within last 3 years)Three Processes, One PowerfulProgram(must have taken within last 3 years)Grade Level Courses(must have taken within last 3 years)Credit Hours Date Taken1 hour1 hour1 hour each1.&2.Discoveree/Super Saturday/FallFestival Courses1 hour each (up &(must have attended during current to 4)year)&3.4.&&Returning Staff(must have volunteered at least 2previous seasons at the same daycamp on the same site)Up to 6 hoursSDC Volunteer Training: April 2nd(Mandatory for new volunteers)2 hours&&SDC Volunteer Training: April 23rd2 hours&&SDC Volunteer Training: May15th(Mandatory for all Unit Leaders)2 hours&&SDC Volunteer ON SITE training:June 13th (Mandatory for All)6 hours&&SDC Online Volunteer OverviewContact staff for login information2 hours&&Total Training Hours Credited&&&
the local Girl Scout Councils or Girl Scouts of the USA. The images will be the sole property of either the local Girl Scout Council or Girl Scouts of the USA. ! I wish to opt out at this time. The Girl Scout Law I will do my best to be honest and fair, friendly and helpful, considerate a
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SONOMA DEVELOPMENTAL CENTER: SITE TRANSFORMATION STUDY 5 Few residents of the Sonoma Valley are unaffected by the changes facing the Sonoma Developmental Center (SDC). The Developmental Center has been a signifi cant employer in Sonoma County for over a century and is widely utilized by the community for rec-reation and enjoyment.
Sonoma State University occupies 269 acres in the beautiful wine country of Sonoma County, in Northern California. Located at the foot of the Sonoma hills, the campus is just an hour's drive north of San Francisco and 40 minutes away from the Pacific Ocean. What's special about SSU? Sonoma State University, a small campus of 9,100 welcoming .
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