Camp Endres 2020 Medical Staff Application

Hi friends! We are so excited for your interest in Camp Endres. Summer will be here before you know it so it's time to start getting things in order. Please remember that you must be at the Camp Endres Training in order to be a staff member at Camp Endres 2020.

Camp Endres Day Camp Staff Training - May 30
Camp Endres Jr. and Sr. Staff Training - June 20

You will be notified by email if you have been selected as a staff member for Camp Endres 2020 with a more detailed information. This email will also request some additional inform so please keep your eye out.

Your participation in diabetes camp is invaluable to the success of our program. Without your help, diabetes camp simply could not exist!

If you have any questions please shoot our Camp and Community Program Director Nat an email at natalie@dsok.net

Thank you so much for making a difference!

Medical Staff Application

This application is for all applicants that are applying to be on our Medical Staff at Camp Endres

General Information
Name*
First Middle Last
Date of Birth*
MM slash DD slash YYYY
Gender*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email*
Cell Phone Number*
T-Shirt Size*
- Adult Small
- Adult Medium
- Adult Large
- Adult X Large
- Adult XX Large
- Adult XXX Large
Do you have type 1 diabetes?*
- yes
- no
Work Preferences
If selected, by accepting a position as a medical counselor, you are entering a contract with Diabetes Solutions-OK, Inc. Although we are unable to pay you for your time, we can reward you in other ways.
What position are you applying for?*
- Dietitian
- Nurse
- NP
- PA
- MD/DO
- Pharmacist
- Mental Health Professional
- Other
Which camp(s) are you applying for?*
please email kim@dsok.net if you cannot be there for the full camp session since continuity of care is our main priority
- Select All
- Camp Endres Day Camp ages 4-10 (June 1-5)
- Camp Endres Sr. ages 14-18 (June 26-July 3)
- Camp Endres Jr. ages 7-13 (July 25-August 1)
Which age group would you prefer to work with?*
- Select All
- 4-5
- 6-7
- 8-9
- 10-11
- 12-13
- 14-15
- 16-18
- any
Which age group would you prefer to NOT work with?*
- Select All
- 4-5
- 6-7
- 8-9
- 10-11
- 12-13
- 14-15
- 16-18
- n/a
Emergency Contact
Name*
First Last
Phone*
Name*
First Last
Phone*
Getting To Know You
Reference Name*
First Last
Relationship*
Phone*
Email*
Name*
First Last
Relationship*
Phone*
Email*
Have you ever been a staff member at a summer camp program?*
- Yes
- No
If you answered yes, where were you a staff member at?*
Please explain why you want to be a medical staff member at Camp Endres*
What do you wishing to gain from this experience?*
In what kind of atmosphere do you feel like you thrive in, and why?*
What can you offer to you other staff members as a co-worker?*
Describe your ideal day a camp*
What is something that can make your day better?*
Please list 6 words to describe yourself*
When you do a great job, how do you like to feel appreciated?*
What is your Instagram handle?*
What is your Twitter handle?*
Voluntary Disclosure Statement
Have you ever been charged with a felony?*
- Yes
- No
Have you ever been convicted in a court of law?*
- Yes
- No
Have you ever been convicted of any crime of violence against minors?*
- Yes
- No
Have you ever been convicted of indecent assault and battery of any kind*
- Yes
- No
Have you ever been convicted of rape of any nature?*
- Yes
- No
Have you ever been convicted of kidnapping of any nature?*
- Yes
- No
Have you ever been convicted of distribution and/or trafficking of narcotics or other controlled substances*
- Yes
- No
Consent*
I agree to the following and that all answers above are truthful

Camp Endres 2020 Medical Staff Application

Medical Staff Application

General Information

Work Preferences

Emergency Contact

Getting To Know You

Voluntary Disclosure Statement