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Message from the Board

We're Here to Help
Medical Support
Tell Us About Your Child

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Activity Highlights

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Fun-tastic Family Events
Bereaved Parents Events
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Photo Galleries

How You Can Help
Donations
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Volunteer

Contact Us

 

Full name: Age:
Date of Birth:    
Home Address: City:
State: Zip Code:
County:    
Home Phone: Work Phone:
Cell Phone: E-Mail Address:

Place of Employment:

 Is it okay to call you at work? Yes No
How did you hear about Courageous Kidz?
Why do you want to volunteer?
Please list any experience working with children, please specify age groups:

Please provide two character references; (these should not be family members)

Reference 1

Reference 2:

Name: Name:
Address Address
Home Phone: Home Phone:
Work Phone: Work Phone:

Please select areas in which you have education, background or skills:

Arts and Crafts Sewing
Culinary Skills Painting/Art
Adventure Course (high ropes, low ropes, climbing wall) Ceramics
Waterfront (Red Cross WSI certification) Woodworking
MEDICAL MD: RN:  
LPN: EMT: PARAMEDIC:  

Current employer and position held:


Final Note:

Applications are available to any person *20+ years or age or older without regard to race, gender
Or religion.

APPLICANT'S CERTIFICATION AND AGREEMENT (Please read carefully)

I hereby authorize COURAGEOUS KIDZ to obtain information pertaining to any charges or Convictions I may have for federal and state criminal law violations. This information will but not be Limited to allegations and convictions committed upon minors, and will be gathered from any law Enforcement agency of this state or any other state or federal government to extent permitted by The state and federal law.

I hereby authorize COURAGEOUS KIDZ to perform a check on my driver's license should I be Required or desire to drive any vehicles belonging to them or rented by them while supplies Are being delivered for activities for COURAGEOUS KIDZ.

I also authorize all persons, public agencies, courts, schools, employer companies and corporations to supply verification of the information provided in my application as well as evaluation of my Prior performances, and I release them from all liability from their doing so.

The above statements are true and complete to the best of my knowledge. Any falsification, Misrepresentation, or incompleteness in this disclosure is alone grounds for disqualification And dismissal. The information that I have provided may be verified, if necessary, by contacting Persons or organizations named in this application.

Please sign your name if you agree to the above conditions:

 

Come see the good times
with our Courageous Kidz!


Birthdays

Cookie-Ramas

Dayz of Magic

Fun-Tastic Family Reunion

Family Dinners

   

 

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