Date of Birth:
Telephone (H):
Telephone (W):
Sask Health Number:
In case of an emergency, whom should we notify?
Contact Person:
Years as a volunteer at Camp Circle O’Friends Inc. (total years including this year):

Volunteer position last year:

Cabin Leader Boys Ages:
Cabin Leader Girls Ages:
Med Shed:

Volunteer position preferred this year:

Cabin Leader Boys Ages
Cabin Leader Girls Ages
Med Shed:
Would you be willing to offer rides to Arlington Beach?:
Would you be willing to assist with camp planning activities?
Willing to do a work bee:
Willing to help with planning:
T-Shirt Size:
I am unable to attend this year’s camp:
Keep my name for next year’s camp:
Volunteer Medical Screening Form
Do you have any medical conditions we need to be aware of?
Explain medical conditions:
Do you have any allergies? If so, how severe is the reaction and what is the treatment?
Explain reactions and treatments:
Do you have any physical limitations, previous back injury, or lifting restrictions?
Explain if Yes
Are you taking any medications?
Explain if Yes
Have you ever had chicken pox or the Varicella vaccine?
Explain if Yes
Have you travelled anywhere within the last 6 months outside of Canada or the US? If so, please list:
Explain if Yes
Are your immunizations up to date?
Explain if Yes
Have you had booster immunizations within the last 10 years?
Explain if Yes
Are you trained in CPR/First Aid?
Explain if Yes
Are you a cancer survivor?
Explain if Yes
Word Verification: