Therapy Staff Application Form

Camp Confidence 2017

Therapy Staff Application Form

This form is to be completed by occupational therapists and occupational therapy students wishing to attend camp.

Camp Information

Welcome to the second year of Camp Confidence! The camp will be held from Monday 2nd October until the 5th October 2017, for 8 to 11 year olds. This Camp is based on the Camp Jabiru model run in Sydney, Australia and it is our pleasure to bring this opportunity to Perth. Camp Confidence allows children a fun and supportive environment to enjoy the camp experience, with the program specifically tailored to meet therapeutic goals. In order to develop confidence emotionally, socially and with their movement, children need to experience the 'just right' challenge. Camp offers numerous opportunities with therapeutic intervention to support children gain greater skills in independence, making friends, managing their feelings and much more! Camp Confidence will be highly staffed with Occupational Therapists and Occupational Therapy Students, an approximate one adult to every two children. Children will be allocated into camp groups with a maximum of 10 children and minimum of 4 live in staff. Parents will receive a daily newsletter with updates from their child's camp group. A nurse will also be on site for the entire duration of the camp to support children with medication and other first aid needs.

Please note: this is a technology free camp, Campers are required to leave all ipads, ipods, phones, computers and electronic games at home unless they are for communication purposes. Therapy Staff will be required to leave all electronics in their dorm strictly out of site from campers at all times.

Attending Camp:

Step 1: Complete and return the 2017 Camp Confidence Therapy Staff Application Form

Step 2: A Calm and Connected staff member will contact you to offer a place – please note that places are limited.

Step 3: You will be sent an invoice to pay the $330 to cover accommodation, food and activity costs. Student discount of $220.

Step 4: Attend the online staff welcome meeting (date TBC) and the pre camp training session on Sunday 1st October. Accommodation is available Sunday night for those travelling to attend camp.

Step 5: Arrive at camp for some fun and learning!

Name: / Date: / //2017

☐Are you an Occupational Therapist?

Current Workplace:
OT Registration Number:
Professional Indemnity Insurance Provider and Number:

☐Are you an Occupational Therapy Student?

University Enrolled:
Current Year Level:

Primary Contact Details

Address:
Primary Phone Number: / Preferred method of contact:
Secondary phone number: / Best time of day to contact:
Email address:

Emergency Contact Details

Name: / Relationship:
Address:
Primary Phone Number: / Preferred method of contact:
Secondary phone number: / Best time of day to contact:
Email address:

Medical Information

Do you have any allergies or medical concerns?
Allergy/Medical / Reaction/symptoms / Treatment
Dietary needs or restrictions:
Any concerns or limitations that will affect your participation on camp?
Are you currently taking any medications:
Medication Name / Comments

About you

Relevant education and training that you have undertaken:

Reason for attending camp:

Please state the goals that you wish to achieve/learn from camp:

Special skills or interests that you may be able to contribute:

Shirt size (for a camp shirt): Female 8,10,12… Male S, M, L…

Swimming ability: poor, average, excellent, bronze medallion

Submitting your Application

For your application to be processed and offered a place, you need to complete all pages in full and provide a photo. You will then be contacted and offered a place. Your position on camp is not confirmed until payment has been received.

Checklist:

◻Application Form

oAbout me pages

oPhoto consent form

oWorking with children card

oNational Police Clearance

◻Attached a photo of you (this is to be emailed to campers introducing their team prior to camp)

Return documents to:

Email:

Post: Kate Keisler, Calm and Connected

6 Ravello Vista,

Yangebup, WA 6164

Camp Confidence

Photo/Video Consent Form

Name: ______

I hereby give permission to the staff of Camp Confidence to make photographic, audio, or visual recordings of me while attending Camp Confidence. Photos/Video of me may be used as indicated below:

Y/N To make a personal documentary history for the children’s camp experience (we plan to give each child copies of photos taken on camp).

Y/N For photos to be used on Calm and Connected’s website to support the description of Camp Confidence – you will be notified.

Y/N For photo’s to be used in promoting Camp Confidence and Calm and Connected

Y/N To be uploaded on Calm and Connected’s social media

Signature: ______

Date: ______

Camp Confidence 2017Calm and Connected Therapy Services