iCan Swim Volunteer Registration Form

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Host name: Jane Kleiman/I Am Fitness
Camp dates: August 19, 2019 - August 23, 2019
Camp location/address: I Am Fitness 205 Harmony Rd. Middletown, NJ 07748

We are pleased to offer this swim program to people with disabilities and look forward to having you play an important part in helping our swimmers reach their goals in the aquatic environment.

***NO PRIOR EXPERIENCE WORKING WITH PEOPLE WITH DISABILITIES IS NECESSARY***

AGE REQUIREMENT: Volunteers must be at least 15 years old.
If you are under 15, please contact the Camp Host for possible opportunities.
SKILL REQUIREMENT: Volunteers must be comfortable in the water

For questions please contact Jane Kleiman at jane.lincroftbike@gmail.com

Volunteer Name *

First Name Last Name

Gender

Male

Female

Clear selection

Date of Birth *

YYYY

T-shirt size

XXL

Clear selection

E-mail address *

Please ensure you have entered a valid email. The Camp Host will use this address when corresponding with you.

Cell Phone *

Please enter 10 digits

Home Address (Number and Street) *

e.g., 123 Parker Pl.

Home Address (City) *

e.g., Fairfax

Home Address (Zip Code) *

5 digits only, please. e.g., 22011

Home Address State/Province *

Emergency Contact Name *

Emergency Contact Phone *

Please enter 10 digits

Parent/Guardian Email (if volunteer is under 18 y/o)

Please ensure you have entered a valid email. The Camp Host will use this address when corresponding with you.

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