Lincoln, NE Area Camp 2021
Carol Joy Holling Conference & Retreat Center | Ashland, NE
Secure Online Event Registration
You are completing this form to be a volunteer of Retreat & Refresh Stroke Camp. Please complete all requested information in each section. Volunteers are required to be at least 18 years of age and be in good health. Anyone younger than 18 will need to request a youth volunteer application for consideration. It is your responsibility to let us know if special accommodations need to be arranged. Healthcare background or training is welcomed, but not necessary.
All volunteers are asked to arrive at camp by 9:30 AM on Friday and asked to stay for the duration of the weekend! Camp ends Sunday afternoon around 2:00 PM. Preference will be given to volunteers who are able to stay for the entire weekend.
In consideration of the health and safety for all of our participants:
Age should be between 18 and 89 as of August 27th, 2021
Our best efforts will be made to accommodate your request, however if you are concerned about having food available that you can eat, we suggest bringing snacks and/or food to supplement your diet.
Your commitment for the retreat weekend would begin by 9:30 am Friday morning for a team building activity and end Sunday around 2:00 PM. For the comfort of our survivors and the continuity of the weekend, it is IMPORTANT to make every effort to attend the entire retreat!
Stroke Survivors and caregivers arrive between 1:30 PM and 3:30 PM on Friday and depart at the close of the event Sunday. We ask that volunteers plan to attend the entire weekend retreat unless other arrangements have been made.
CAMP DATES: Friday, August 27-Sunday, August 29, 2021
Volunteers are NOT expected to assist survivors and caregivers with activities of daily living (bathing, dressing, grooming, etc...) The following activities are some you MAY be asked to assist with while at camp. Volunteer assignments are made AT camp, and all volunteers are asked to assist where ever they see a need. (Activities vary based on retreat center, location, time of year, and accommodations.)
Depending on the facility, volunteers typically share a sleeping room with one or more volunteers of the same gender. If you have a friend, colleague, or spouse volunteering for this camp that you would like to room with, please list their name(s) here. While there are NO guarantees, we will do our best to accommodate rooms requests.
There are opportunities for educational/experiential sessions throughout the retreat weekend. If you have a topic of interest and would like to present, please list it here and we will be in touch.
Approximately one or two weeks before camp, VIA EMAIL, you will receive:
I hereby authorize Retreat & Refresh Stroke Camp ("Camp") to use, publish, and/or disclose my Individual Identifiable Information ("Information") as described herein. This authorization is voluntary. No individual has coerced or forced me into signing this authorization. I am providing this authorization under my own free will. I am under no legal liability.
I understand that Camp may benefit, monetarily, non-monetarily, or otherwise, from the use of my own Information. I understand that I will not be entitled to any of said benefits and specifically release all claims to same. I understand that once Information is received by Camp, then it may be subject to re-disclosure and may no longer be protected by federal, state, or local laws. I waive any claims of violations of federal, state, or local laws which are the result of re-disclosure.
A. Individually Identifiable Information includes, but is not limited to:
B. Purpose of request:
C. Right to Revoke
I acknowledge that I have the right to revoke this authorization only in writing. Any revocation will be prospective and not retrospective.
By checking the box below, I acknowledge and affirm the statements in this authorization form.
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