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workcampNE registration form - (*) required fields First Name:* Last Name:* Street:* City:* State:* Choose One Alabama Alaska Arizona Arkansas California Colorado Connecticut Deleware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip:* Home Phone:* Cell Phone: E-mail: Twitter Screen Name: @     workcampNE, Inc. requires that ALL participants have health insurance. Please understand that your personal health insurance will have to cover any medical treatment. Date of Birth:* Date of last Tetanus Shot:* If greater than 10yrs, a booster is required. Insurance Company:* Insurance Company Phone Number:* Insurance Policy Number:* Insurance Group Number: Emergency Contact Name #1:* Emergency Contact Phone #1:* Emergency Contact Name #2:* Emergency Contact Phone #2:*     Camp Date:* Choose Camp July 11-17 (Kennebunk, ME) July 18-24 (Kennebunk, ME) August 1-7 (Sunapee, NH)  ** August 1-7 Jr. High Only T-Shirt Size:* Choose XS S M L XL XXL XXXL  ** T-Shirts are in men sizes Gender:* Choose Male Female Church/Group Name:* If coming as an independent camper, fill in text box with "INDEPENDENT".     How would you rate your experience and preferences in the following areas? Please use the following scale: Experience: 0 - I have never done this 1 - I have done this at a previous camp or have helped others or have limited experience 2 - I am pretty good at this and with some initial guidance could be left alone to finish the job 3 - I have a lot of experience or get paid for doing this Preference: 0 - I prefer not to do this 1 - I am a little uncomfortable, but willing. 2 - I'd prefer to do this as I am very comfortable doing this. 3 - I'd really like to do this. EXPERIENCE PREFERENCE Deck/Stairs/Ramps:* Choose One 0 1 2 3 Choose One 0 1 2 3 Framing or Finish Carpentry:* Choose One 0 1 2 3 Choose One 0 1 2 3 Painting:* Choose One 0 1 2 3 Choose One 0 1 2 3 Roofing:* Choose One 0 1 2 3 Choose One 0 1 2 3 Replacing Windows/Doors:* Choose One 0 1 2 3 Choose One 0 1 2 3 Drywall:* Choose One 0 1 2 3 Choose One 0 1 2 3     The following section is for ADULT VOLUNTEERS ONLY. Which leadership role would you prefer while attending workcampNE? Crew Leader: Lead a group of 5/6 students providing spiritual and task guidance. Choose Yes No Go-for: Run errands to the hardware store(s) or camp’s tool room getting last minute materials/tools for the crews. This allows the crews to continue working uninterrupted. Choose Yes No Troubleshooter: Professional or very experienced individual to lend expertise and oversight to crews requiring assistance in the completion of tasks. This person does not lead a crew. Their role is to oversee 3 to 5 crews and ensure the completion of assigned work. Choose Yes No Kitchen: Prepare meals for all campers. Day starts at 5AM, with a break from 10-2, resume from 3-6 for dinner preparation and kitchen clean up. Students clean the cafeteria. Choose Yes No First-Aid: Monitor the health of the campers and administer first aid when necessary. Experience is preferred as decisions need to be made when assessing the severity of injuries and the type of medical attention required. Choose Yes No Night Monitor: Keep watch over camp during the overnight period. These hours are from 11PM to 6AM. Choose Yes No     Please complete the remainder of the form to the best of your knowledge. If not applicable, please fill in the text field with "N/A". Allergies:* (medical, food, latex or nature) Please list any medical conditions:* Current medications:*

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