VolunTeen Packet and Application - South Suburban Parks and ...

Dear VolunTeen Applicant, Are you ready to have fun this summer? Apply to be in our VolunTeen Program! Here you will gain valuable work experience and earn community service hours while creating wonderful memories. A limited number of positions are available in recreation, golf, cultural arts, nature and outdoor programs. If selected into the program, you will receive volunteer training, a South Suburban photo identification badge and an exclusive t-shirt. The participant’s schedule will be determined by the needs of the individual programs as well as their availability. Additionally, if selected into the VolunTeen program, you must attend a mandatory orientation at South Suburban’s Buck Recreation Center, 2004 W. Powers Ave., Littleton. The meeting will take place on Friday, June 2nd, from 8:30am-12:30pm. The VolunTeen Application includes the following sections:    

VolunTeen Program Information Sheet VolunTeen Application (2 pages with full payment required) VolunTeen Applicant Recommendation Form* (forms to be completed by 3 unrelated adults) Signed VolunTeen Participant Contract

Please download, complete and submit all sections of the online VolunTeen application by Friday, April 14, 2017 to: South Suburban Administration Building 6631 S. University Blvd. Centennial, CO 80121 or email: [email protected] * For purposes of confidentiality, please request that references complete the VolunTeen Recommendation Form, and submit it by Friday, April 14th, 2017 to: South Suburban Parks and Recreation Attn: VolunTeen Coordinator 6631 S. University Blvd. Centennial, CO 80121-2913 or email: [email protected] For questions, email [email protected], or call 303-483-7000.

2017 VolunTeen Application Name________________________________________ Date______________________ Address__________________________________ City/Zip _______________________ Home Phone __________________________ Cell Phone_________________________ Email Address (s) ________________________________________________________ Birthdate: _________ Current Grade _____ School Name: ________________________ Areas of Interest: (circle all that apply)

Mini-Golf

Nature

Sports

Golf

Art

Special Skills or Interests: _______________________________________________________________________ _______________________________________________________________________ T-Shirt Size (circle one) Youth

M

L

Adult

S

M

L

XL

Please check the weeks and time of day you are available. Note: You must be available to work at least a minimum of 3 days at the same site during the weeks you select. Shifts

Week of June 5

Week of June 12

Week of June 19

Week of June 26

Week of July 3

Week of July 10

Week of July 17

Week of July 24

Week of July 31

A.M. P.M. Are you aware of other activities that would limit your volunteer work? i.e., vacation, job, camp, summer school, etc. _____________________________________________________________ ______________________________________________________________________________

Emergency Contact Information: Parent/Guardian name: ____________________________ Daytime/cell #: _________________ Parent/Guardian name: ____________________________ Daytime/cell #: _________________ Alternative Contact: _______________________________ Daytime/cell #: ________________ Doctor’s name: __________________________________ Phone #: _______________________ Health Insurance Co: _______________________ ID#_________________________________ Person’s name on policy: _________________________________________________________

I hereby certify that all statements made in this application are true. I acknowledge that any false statement or misrepresentation on this application will be cause for refusal of placement or immediate dismissal at any time during my period of placement. I understand that I am working at all times on a voluntary basis without compensation and not as a paid employee, and that this agreement can be cancelled at any time by either me or a South Suburban Park and Recreation District employee. Medical Authorization I authorize South Suburban Parks and Recreation to obtain emergency transportation and any medical treatment necessary for my child in the event of injury or illness. I understand South Suburban Parks and Recreation does not carry accident insurance for this program and that the participant’s personal health insurance will be used to pay for any medical expenses incurred. I further understand that any volunteer job-related injury, regardless of severity, must be immediately reported to the supervisor. I understand and agree to the above terms and agree to allow my child to participate in the South Suburban Parks and Recreation VolunTeen program. ___________________________________ Parent/ Guardian

Date

_________________________________ Participant

Date

The following is a consent and release agreement. Please read it carefully and sign below. A parent or guardian must also sign this consent and release agreement. I, (please print full name) _____________________________________________, understand that my services are being offered on a volunteer basis without anticipation of financial remuneration and I indemnify and hold harmless South Suburban Parks and Recreation and its employees, agents, leaders, instructors, contractors or volunteers from, and against all claims, demands, loss or injury to my person or property incurred through negligence, or other acts or omissions, however caused, by an officer, employee agent, leader, instructor, contractor or volunteer of South Suburban Parks and Recreation as a result of, or during my participation in volunteer service. I acknowledge that I have carefully read and fully understand this agreement and its contents. I am aware that this is a release of liability and a contract between me and the South Suburban Parks and Recreation VolunTeen Program and/or its officers, employee agents, instructors and volunteers, and I sign it on my own free will. VolunTeen Program Price: Residents: $60; Non-Residents: $65. To verify resident status, call 303-347-5999. A current South Suburban ID card is required for resident rate. Please record South Suburban ID # __________________ Payment must accompany application: Credit Card # ________________________ Expiration Date ___________ Checks also accepted. Payment received ___________ (date) I give my permission to use my photograph for any official South Suburban Parks and Recreation purposes. Signature of Participant: ______________________________________ Date: _________________ Signature of Parent/Guardian: ________________________________________________________ How did you learn about the VolunTeen program? ________________________________________ ________________________________________________________________________________

VolunTeen Participant Contract Please review this contract with your parent/guardian and place your initials next to each requirement indicating that you have read and agree to adhere to South Suburban’s policies. As a participant in the VolunTeen program for South Suburban Parks and Recreation I, (name)__________________________________________________________________ _______

Will be on time for all assigned programs and the MANDATORY VolunTeen Orientation on Fri., June 2 at 8:30 am at Buck Recreation Center.

_______

Will show respect toward South Suburban staff, my peers and the participants with whom I work.

_______

Will be dependable by working all the hours for which I am scheduled and will give at least 24 hours notice to my supervisor if a problem arises which would prevent me from performing my duties.

_______

Will complete the tasks assigned to me to the best of my ability.

_______

Will make efficient use of my time by seeking out ways in which I may help others after completion of my own responsibilities.

_______

Will dress appropriately, as defined in the VolunTeen Handbook.

_______

Will not allow personal problems or conflicts to interfere with my volunteer performance or interaction with participants.

_______

Will maintain a positive attitude and remain flexible to change

_______

WILL HAVE A GREAT EXPERIENCE THIS SUMMER!

Failure to comply with this contract will result in the following consequences: 1st violation: Warning and review of contract 2nd violation: Phone call to parent/ guardian 3rd violation: Office meeting between South Suburban staff and parent/ guardian. A change in schedule; a reduction in hours; or dismissal from VolunTeen Program may occur. Important Note: South Suburban Parks and Recreation reserves the right to handle extreme contract violations at its own discretion. In situations where the participant’s actions jeopardize the safety of anyone involved in our programs, the District will immediately dismiss the particpant. I have read and initialed each item in this contract and agree to adhere to this policy. ___________________________________________ Participant Name

_______________________________________ Date

___________________________________________ Parent/Guardian Name

_______________________________________ Date

VolunTeen Applicant Recommendation Form (Please make copies of form - three references required) Part 1 (to be completed by applicant) Applicant’s Name __________________________________________________ Date _______________ Part 2 (to be completed by adult reference) The youth named above has applied to serve as a participant in our VolunTeen program at South Suburban Parks and Recreation and has listed you as a reference. As part of the application process, please complete this form and submit it by Friday, April 14th, 2017 to: South Suburban Parks and Recreation Attn: VolunTeen Coordinator 6631 S. University Blvd., Centennial, CO 80121-2913 or email: [email protected]. Questions? Call Shauna at 303-483-7000. How long have you known the applicant? ___________In what capacity? _________________________ Name of Reference ________________________________ Daytime Phone _______________________ Email: _______________________________________________________________________________

Attitudes and Personal Qualities Appearance Punctuality Reliability Cooperation with peers Acceptance of rules Willingness to accept criticism Ability to follow directions Able to work independently Leadership Initiative Enthusiasm Works well with children Works well with adults

Excellent

Good

Fair

Poor

N/A

Comments: ______________________________________________________________________________________________ ______________________________________________________________________________________________

I (circle one) DO DO NOT recommend the above youth for participation in South Suburban Parks and Recreation’s VolunTeen program. Signature: _____________________________________________

Date: _____________________