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- Programs
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Burn Survivors
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Get Involved
About Us
- Our Mission
- Our Team
- Contact Us
- News
- Financials

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Camp Beyond the Scars

Volunteer Application

Camp Beyond the Scars Counselor Application

When: July 10-15, 2022

Where: Doane Valley

Qualifications to be a Volunteer Cabin Counselor or Staff member:
• Be 21 years of age or older
• Energetic, outgoing and friendly
• Ability to remain friendly, positive and respectful in a stressful environment
• Possess effective communication skills that demonstrate appropriate tact and diplomacy
• Patient with children of all ages and abilities
• Comfortable interacting with people you do not know
• Able to handle multiple functions effectively in varying environments

Time Commitment – Volunteer Cabin Counselors and Staff members will be required to remain at camp full time and for the duration of the camp program.

Training – Volunteer Cabin Counselors and Staff members will attend an Orientation and Training. Counselor assignments are not confirmed until the completion of Orientation. Please submit a current Certificate of Completion for Mental Health First Aid or similar if in the medical/mental health field. Mental Health First Aid offers free seminars throughout the year. Visit mhasd.org for more information.

Steps to Become a Volunteer Cabin Counselor or Staff member:
• Complete this online application
• Attend a required Cabin Counselor Interview (new counselors only) to be assigned
• Submit 2 references (new counselors only)
• Once application is accepted, conduct a Live Scan screening (new counselors only)
• Attend the necessary training sessions

This application is not a guarantee of your acceptance to be a volunteer with Camp Beyond the Scars. You will be notified once your application has been received and accepted. If you have any questions or concerns about volunteering to be a camp counselor or staff member, please contact Leilani Stone at (858) 541-2277. Deadline to apply will be May 31, 2022.

Step 1 of 7

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Volunteer Cabin Counselor & Staff Application
Name*
First Last
DOB*
Month
Day
Year
Mailing Address*
Street Address City State / Province / Region ZIP / Postal Code
Phone*
Email*
Occupation, if fire station - what department and station?
T-Shirt Size (Unisex)*
- XS
- S
- M
- L
- XL
- XXL

Are you new or returning?*
Have you ever known or worked with burn survivors before?*
How did you learn about Camp Beyond the Scars? If referred by whom?*
Why are you interested in volunteering at Camp Beyond the Scars?*
List experience you have working with children, if any.*
Please list any second language you speak.
Do you have any special skills/talents/contributions you would like to bring to Camp Beyond the Scars? ( ABA, ASL, musical instruments, etc.)
List current certificates/licenses and expiration dates. Include CPR/AED, First Aid, Mental Health First Aid.
Are you able to attend MANDATORY July 10, 2022 orientation?*
- Yes
- No
Burn Survivor Applicant
Skip the next question if you are not a burn survivor.
We welcome burn survivors to volunteer, but respectfully request you share about your personal experience. Please describe your burn experience

Health
Please answer the following questions honestly and to the best of your knowledge. Your personal information will only be divulged to staff and professionals who need to know of medial situations for your safety and the safe conducting of camp activities. By filling this application, you agree that you have fully disclosed any health or medical conditions. If questions do not apply, please skip.
Do you have any dietary restrictions and/or allergies?
Name of Health Insurance
Primary Care Physician (PCP)*
PCP phone number*
Do you have any medical/mental/emotional conditions that would hamper your ability to perform the essential functions of the job of Volunteer Cabin Counselor?
Current Medications - please notify Burn Institute staff if you are taking more than one medication.
Medication Name
Dose and Purpose
Have you received your COVID 19 vaccination?*
- Yes
- No
Please list the dates of the 1st and 2nd vaccination (and booster if applicable)
Name of Emergency Contact
First Last
Phone*
Relationship to you*
Personal References (For New Counselors Only)
Provide two (2) contacts you are not related to who have knowledge of your character, experience, and ability. Skip this section if you are a returning counselor.
Reference 1 Name
First Last
Phone
Email
Reference 2 Name
First Last
Phone
Email

Criminal Background History and Authorization to Investigate
Have you ever been convicted, fined, place on probation or imprisoned of any crime?*
- Yes
- No
I UNDERSTAND THAT:
I understand that the Burn Institute will conduct DOJ, FBI and National Sex Offender background checks. I understand that if circumstances are discovered that would indicate a 'yes' answer to the above question, consideration to participate may be terminated immediately. I understand that camp may terminate my participation if found, regardless of when discovered, to have any of the following: - history of complaints of abuse or neglect towards a minor - resigned, terminated, or asked to resign from a position, paid or unpaid, due to complaint(s) of sexual abuse of a minor - falsified or omitted information in this disclosure statement. I also understand that untrue, misleading, or omitted information herein or in other documents completed by me may result in dismissal, regardless of when discovered, by the camp. I authorize investigation of all statements herein, including any checks of criminal records, and release the camp and all others from liability in connection with the same.
Initial if you agree with the above statement

Photo/Video/Publicity Release
I authorize the Burn Institute and it's authorized partners to use photographs, videos, interviews, and artwork taken, created, and/or submitted during Camp Beyond the Scars. This includes any/all camp programs and activities undertaken throughout the week. I permit the Burn Institute and it's authorized partners to use and publish photographs, videos, interviews, and artwork for publicity purposes including Burn Institute publications, activities, literature, fundraising, and/or news media. I agree to hold harmless the Burn Institute, its officers, agents, employees and authorized partners from any liability resulting from or arising in connection with the taking, publication, and/or release of the photographs, videos, interviews, and artwork.
Initial below if you agree with he above statement

Important Agreement - Please Read Before Signing
Initial below if you agree with the above statement.

THANK YOU!
Thank you for applying to Camp Beyond the Scars 2020! We will be reviewing applications and you should anticipate hearing from us within the next month. If you have any questions, please contact Leilani Stone at Lstone@burninstitute.org.

San Diego, CA

8825 Aero Drive, Suite 200
San Diego, CA 92123

P. (858) 541-2277

Imperial Valley, CA

612 J Street, Suite 3
Imperial, CA 92251

P. (760) 355-3175

F. (760) 355-0836

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