August 7 – 10, 2025 • Payson, Arizona Camp Brain 2025 Volunteer Application 2025 Camp Brain Volunteer Full Application "*" indicates required fields Step 1 of 2 50% Name* First Last Nick Name Birthdate* Month Day Year Home Phone*Cell Phone*Email* Contact Preference* Home Phone Cell Phone E-mail Text Message T-SHIRT Size* Small Medium Large X-Large 2X-Large 3X-Large 4X-Large 5X-Large 6X-Large Address* Street Address City AZAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State Zip Code Why do you want to volunteer for Camp Brain*Have you volunteered before for Camp Brain?* YES NO Do you know anyone else volunteering who you would like to be paired with, if possible?* YES NO Who would you like to be paired with?*What are your credentials, certification, licenses, and job title*DEMOGRAPHICSGender*Select from ListMaleFemaleNon-binaryPrefer Not to AnswerEthnicity*Select from ListAmerican Indian or Alaska NativeAsianBlack or African AmericanHispanic or LatinoNative Hawaiian or Other Pacific IslanderWhitePrefer not to answerCamp Participation*Camp will run from Thursday, August 7th until Sunday August 11th. We ask that you arrive at 2PM on Thursday and you can depart by 1PM on Sunday. Which days are you able to attend ? Thursday - August 7 Friday - August 8 Saturday - August 9 Sunday - August 10 Select AllWEBINAR: Volunteer OrientationJoin us for an information session. We’d love to say hello and discuss all the ways we can work together to make camp a fun and safe experience. Fri - May 30 | 6:00-7:00pm Sat - Jun 14 | 9:00-10:00am Thu - Jun 19 | 7:30-8:30pm TransportationWill you be driving your own vehicle?* YES NO VEHICLE INFOPlease provide us with your vehicle information for our records and evacuation plan.Vehicle Make*Model*Year*How many seats in the vehicle?*Driver License*Car License (include state)*This field is hidden when viewing the formSECTION ENDMOBILITY NEEDSDo you have any mobility needs that we can work with you to accommodate? YES NO Please describe your mobility needs*EMERGENCY CONTACTSPlease select someone who is not accompanying you on this trip. PRIMARY EMERGENCY CONTACTPrimary Contact Name* First Last Phone*Email* Relationship* SECONDARY EMERGENCY CONTACTSecondary Contact Name* First Last Phone*Email* Relationship*This field is hidden when viewing the formPhoneHealth Care NeedsDo you have any healthcare concerns or issues that you would like us to know about, should you become incapacitated and unable to speak for yourself?* YES NO Please describe your healthcare concerns or issues that you would like us to know about, should you become incapacitated and unable to speak for yourself*Are you prone to seizures?* YES NO What causes your seizures?*When was your last seizure?* Month Day Year Do you have allergies to any medications?* YES NO If "YES" please LIST the MEDICATIONS and the REACTIONS below*Are you allergic to latex or latex products? YES NO Are you allergic to any foods, animals, or insects?* YES NO Please describe which foods, animals, or insects you are allergic to below:*Additional InformationAny comments or additional information you'd like to provide? FOOD ALLERGIES & PREFERENCESDo you need a special diet?* YES NO If "YES" please specify below* NO Dairy NO Nuts Gluten Free Vegetarian Vegan OTHER If "YES" please specify below:*This field is hidden when viewing the formEnd Section Whispering Hope Ranch | Brain Injury Association of Arizona PHOTOGRAPHY RELEASEPHOTOGRAPHY RELEASE*I consent to and authorize the use and reproduction by Whispering Hope Ranch (“WHR”) or Brain Injury Association of Arizona of any and all photographs and any other audio-and/or video recordings of the voices and images taken of me and/or my child(ren)/ward(s) for promotional material, educational activities, use on WHR’s website, exhibitions or for any other use for the benefit of WHR. I hereby waive any claim for payment or other compensation for any such use by WHR of my and/or my child’s(children's)/ward’s photographs and/or any other audio and/or video recordings. I HAVE CAREFULLY READ THE ABOVE RELEASE AND CONSENT WITH FULL KNOWLEDGE OF ITS CONTENTS AND SIGNIFICANCE.CAPTCHAEmailThis field is for validation purposes and should be left unchanged.
