Please complete and return by one of the following methods:

Email: Discovery Camp CIT

Fax:215-448-1314 Volunteer Application

Mail: The Franklin Institute Volunteer Office

222 North 20th Street

Philadelphia, PA 19103-1194

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Name ______

Please print or type

Address______

City, State, Zip______

Home Phone (____)______Cell Phone ( )______Birthdate ______

Education (List the grade you will enter in the fall)______

Name of High School______

E-mail Address______

Emergency Contact Name______Emergency Phone ( )______

ALL CIT’s must be available for at least 3 full camp session (camp sessions are one week in length). Please see The Franklin Institute website for session dates and themes

List your session availability:______

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Please list job or volunteer experience (places, dates of service, positions held and reasons for leaving- feel free to attach resume):

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Please list skills, hobbies, training, or interests that apply (for example: foreign language, public speaking, biology, etc):

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Why do you want to volunteer at The Franklin Institute? ______

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How did you hear about volunteering at The Franklin Institute? ______

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Essay Questions - Please answer the following essay questions. You may attach an additional sheet if necessary:

  1. In a few paragraphs, tell us why you want to volunteer with Discovery Camp and what impact you think you could have on a camper’s experience at Discovery Camp:
  1. Please describeany experiences you have had working with children (family included) :

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References - Please list two people, not related to you, whom we may contact for references. At least one must be a professional reference. If you have never worked, feel free to list a teacher or other adult as your professional reference.

1. Name: ______Relationship: ______

Email: ______Telephone: ______

2. Name: ______Relationship: ______

Email: ______Telephone: ______

Have you ever been convicted of a crime, other than minor traffic offenses?  Yes  No

If yes, explain (A conviction is not an automatic disqualification.) ______

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The Franklin Institute reserves the right to conduct Child Abuse History Clearances and/or Criminal Background Checks.

I understand that I am applying for a position as an unpaid volunteer at The Franklin Institute and that submission of this application does not guarantee placement in the volunteer program.

Signature: Date:

Parent or Guardian Signature:

Youth Volunteer Permission Slip for Discovery Camp

(Name of youth)______is interested in volunteering for The Franklin Institute. Since he/she is under the age of eighteen (18), we need your permission to complete the placement. If you have no objection, please sign and return the bottom portion of this form to:

The Franklin Institute

Volunteer Program

222 North 20th Street

Philadelphia, PA 19103

Fax: 215-448-1314

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Return this portion to The Franklin Institute.

I hereby give permission for ______(youth’s name) to volunteer with The Franklin Institute’s Discovery Camp.

I hereby give The Franklin Institute (TFI) staff permission to administer basic first aid when applicable, including the treatment of minor cuts, scrapes, burns (including sunburns) and stings. Medication will not be administered by TFI staff at any time. I hereby give permission to medical personnel and Emergency Medical Services selected by the staff of TFI to provide transportation and treatments, including X-raysand routine tests, for my child. In the event that I cannot be reached in an emergency, I hereby give permission to the physician/hospital where my child is transported to secure and administer treatment, including hospitalization and surgery, for my child. The completed forms may be photocopied for trips out of camp. I agree to assume financial responsibility for all medical and hospital expenses.

I hereby give The Franklin Institute the right to conduct a background check on my child for the purpose of volunteering. The areas that will be checked are criminal record and child abuse history. My signature gives my consent to allow this background report to occur.

On behalf of the child / minor, I hereby release, discharge, and hold harmless, The Franklin Institute, and their officers, trustees, agents, and employees from and against all losses, claims, actions, costs, expenses and/or damages, including attorney fees, arising out of my / our child’s participation in The Franklin Institute’s Volunteer Program, except for the willful misconduct or gross negligence of The Franklin Institute.

The Franklin Institute also has permission to use my child's photograph or videotaped image in publicity about the Institute and its activities. ___Yes ___No

I / We have carefully read this release prior to its execution and I / we fully understand its contents.

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Signature of Parent/GuardianRelationship to child

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Date

Updated 5/27/14 JC