2015 BAE Vet Camp Counselor Program & Application

Students (18 and older) who are currently enrolled in college or veterinary school may apply for our volunteer BAE Vet Camp Counselor Program. As a volunteer camp counselor working side by side with Jamie Textor, DVM, PhD, you will earn practical and clinical hours required for veterinary school applications and course work.

1. Please complete and submit the following BAE Vet Camp Counselor Application Registration Form.

2. In the application, you will be asked to upload your Academic Résumé and a scanned copy of your Driver’s License (photo ID).

Background checks will be performed on all counselor applicants, and BAE Vet Camp Director Shanna Gage Lai will conduct interviews. Those applicants who qualify for the position will be invited to become volunteer BAE Vet Camp counselors.

Counselor Application

Name

SSN

Date of Birth:

Age as of 8/1/15:

Academic Resume: (PDF)

Copy of Driver's License: (JPEG)

Address

Phone

E-mail

What college do you attend?

What is your major?

Do you speak other languages besides English? If Yes, please list other languages:

Do you have youth camp experience? Please describe.

While equine experience is not necessary, do you have equine and/or veterinary medicine experience?

Why are you interested in becoming an Equine Vet Camp counselor?

Are you considering veterinary school?

Do you need to earn practical and clinical volunteer hours working with a veterinarian for your vet school application?

How would volunteering at BAE Vet Camp help you reach your academic or career goals?

Did you attend summer camp as a child?

On a scale of 1–10 (where 1 is the lowest, and 10 is the highest), what is your level of commitment to 2015 BAE Vet Camp? Are you committed to serving as a camp counselor all day, every day, for the week of August 1–7, 2015, 8am–5pm? Do you anticipate conflicts with that schedule?

Is there anything else you would like to share about yourself, your interest in veterinary medicine camp, and/or your camp counselor qualifications?

2015 BAE Vet Camp Application

Parent/Guardian Information

First Name (required)

Last Name (required)

Email (required)

Phone Number (required)

Street Address

City

State

Zip Code


Student Information

First Name (required)

Last Name (required)

Birthdate (required)

Grade in Fall 2015 (required)

School (required)


Emergency Information

Emergency Contact Name (required)

Relationship to Student (required)

Emergency Contact Phone (required)

Physician's Name

Physician's Phone

Insurance Carrier


Health History

Physical/Cognitive special needs or challenges? (required)

N/A if none.

Activities limited by physician? (required)

Any allergies, including food? (required)

Asthma? (required)

If yes to any of the above, please give us additional details and instruction.


Medications

Does you/your student use an EpiPen? (required)

Does you/your student use an asthma inhaler? (required)

Currently taking medication?

If yes to any of the above, please give us additional details and instruction.


Background

Anything we need to know to ensure the safety of you/your student? (ex. custodial issues, phobias, etc.)?

Anything we need to ensure the most enjoyable experience for you/your student?


Riding Level:

Riding Style:

Interested in Veterinary Medicine?

If you are interested in Veterinary Medicine, Please tell us about your past experiences in the Veterinary field:

T-Shirt Size:

Do you own a horse?

At which stable do you ride?

Interested in joining BAE Club?

How did you hear about us?

If you saw a flyer, where was it located?


Authorized Individuals for Release

Authorized Individuals

BAE Club staff is authorized to release my student into the care of the following people. Please provide the name, relationship to student and contact phone number for each individual.

Exclusive Workshops/Field Trip Permission

My student has my permission to accompany Bay Area Equestrian Club, its camp counselors, mentors and its agents on all club sponsored field trips during camp. I understand that I will be notified in advance of any special instructions. Unless otherwise notified, students are to wear the BAECamp t-shirt on all field trips.


Swimming:

My student is a swimmer:

Permission to swim:



Acknowledgements

Medical Policy (required)

I have read, understand and agree to the Medical Policy.

Allergy Policy (required)

I have read, understand and agree to the Allergy Policy.

Tetanus & Rabies Waivers (required)

I have read, understand and agree to the Tetanus and Rabies waivers.

Photo Release

I have read, understand and agree to the Photographic Release.

Application Agreement (required)

I have read, understand and agree to the Application Agreement.

Type your full name into the E-Signature box below. By doing so you acknowledge that is serves as a legal signature. You certify that the information entered in the registration form is true and correct as entered above.


E-Signature:

E-Signature Date: