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					      SPORTS BUDDIES & ARTS BUDDIES MENTOR APPLICATION
            MENTORING PROGRAMS OFFERED THROUGH JEWISH BIG BROTHERS BIG SISTERS OF LOS ANGELES
                                     HOSTED AT CAMP MAX STRAUS
                  6505 Wilshire Boulevard, Suite 600      ●   Los Angeles, CA 90048         ●   (323) 761-8675

MENTOR INFORMATION
    First Name:                                      Last Name:

    How did you learn about the program?
    Requested Program?                □ Arts Buddies          Or           □ Sports Buddies

    Address:                                                             Email:

    City:                                            State:                                Zip:

    Phone: (        )                                Type of Phone Number:

    Phone: (        )                                Type of Phone Number:
                                                                                   (Home, Beeper, Work, Etc.)
EDUCATION INFORMATION          (Are you currently enrolled?             No        Yes)
      College/University        Emphasis of Study                     Dates                       Degree Granted




EMPLOYMENT INFORMATION           (If you are not currently employed check here                    )
    Occupation:                                            Length of current employment:

    Employer:
    Address:

    Supervisor:                                            Supervisor’s Phone Number:
    May we contact your employer for a reference?

BIG BROTHER OR BIG SISTER INFORMATION
    Are you currently a Jewish Big Brother or Big Sister?             No          Yes

    If your Little Brother or Little Sister will be participating with you, what is his/her name?


REFERENCES      (A person not related to you who has knowledge of your character and history.)
    First Name:                                            Last Name:

    Address:

    City:                                                  State:                           Zip:

    Phone: (        )                                      Type of Phone Number:

    Relationship:                                          Length of Association:


    First Name:                                            Last Name:

    Address:

    City:                                                  State:                           Zip:

    Phone: (        )                                      Type of Phone Number:

    Relationship:                                          Length of Association:
                                      (Please fill out the backside of this application)
EMERGENCY CONTACT
    Name:                                            Relationship:

    Phone:

    Address:

    City:                                            State:                    Zip:

CONFIDENTIAL INFORMATION         (Required for clearance to work with minors.)
    Birth Date:                                      Social Security Number:

    Drivers License Number (or State ID Number):                             State of Issue:

BACKGROUND INFORMATION
    Do you have any emotional or physical disabilities or special needs which would prevent you
    from safely performing any of the duties of the volunteer position for which you have applied?
    If yes, please attach explanation to this form.

    Have you ever been convicted of a felony?        If yes, please attach explanation to this form.

   I authorize investigation of all statements herein and release JBBBS and CMS and all others from
   liability in connection with same. I also understand that untrue, misleading, or omitted
   information herein may result in dismissal regardless of the time of discovery by JBBBS and CMS.


   Signature:                                                  Date:




                       PHOTOGRAPHIC RELEASE: (Requested, but not required.)

    I,                                 hereby grant permission to Jewish Big Brothers Big Sisters
    of Los Angeles and Camp Max Straus to photograph me and to use my name in conjunction
    with their public relation program. I further release and discharge any claim or cause of action
    I have or may have in the future of damages against Jewish Big Brothers Big Sisters of Los
    Angeles and Camp Max Straus, incurred in or arising as a consequence of the use of my name
    or photographs of me in their public relations effort.

    Signature:                                                    Date:




   Please return to:
                                          Camp Max Straus
                       Attn: Sports Buddies & Arts Buddies Mentoring Program
                                     6505 Wilshire Blvd., Suite 600
                                        Los Angeles, CA 90048
                                          VOLUNTEER MENTOR AGREEMENT

MENTORS MUST COMMIT FOR ALL FIVE DATES IN ORDER TO SIGN-UP FOR ANY SEASON. (Exceptions are
discussed with the Program Director). One of the program’s goals is to provide a dependable role model for the
children, this consistency and dependability is important in a child’s life. Please check your schedule and mark the
following dates on your calendar. Please read all sections of this agreement sign it and return to us.

                                                 Winter Season 2007

                                Sunday,   January 7            9:30 a.m. - 3:15 p.m. (Orientation included)
                                Sunday,   January 14          10:30 a.m. - 3:15 p.m.
                                Sunday,   January 28          10:30 a.m. - 3:15 p.m.
                                Sunday,   February 25         10:30 a.m. - 3:15 p.m.
                                Sunday,   March 11            10:30 a.m. - 3:15 p.m.

Working with youth can be both challenging and rewarding. The following guidelines have been established to
promote a safe and fun program. They have been written for your protection as well as for the safety of the youth
participants.

1.    The volunteer mentor is expected to uphold the goals and objectives of the Camp Max Straus – Sports Buddies &
      Arts Buddies Program. The first interest of every volunteer mentor is the youth participant. The program exists
      for them. Our Mission: To provide a non-sectarian mentoring program for children from single-parent
      households through the medium of sports and arts.
2.    The volunteer mentor’s time is at the disposal of the camp. He/she will be expected to follow the directions of
      the Program Director and Coaches and take part in all program activities assigned.
3.    Pre-event training, and /or ongoing training in camp, may be required of all volunteer mentors.
4.    It is the responsibility of each volunteer mentor to personally observe and cause participants to observe all
      policies established for health and safety purposes.
5.    The possession of alcohol or illegal drugs on camp property is not permitted at any time. The use of, or
      being under the influence of alcohol, marijuana or other drugs while on camp property is grounds for
      immediate dismissal. Volunteer’s personal property is subject to search at any time.
6.    The City of Glendale Fire Marshal had designated Camp Max Straus a Smoke Free Zone. Smoking on the camp
      property (including the parking lot and adjacent areas) is grounds for dismissal.
7.    Never allow yourself to be left alone with a participant. Volunteer mentors will not escort the youth to any
      area of camp by him/her self and must stay within the boundaries as set forth by the program staff.
8.    Mentors will use only appropriate physical touch and will never use harsh or demeaning language. Volunteer
      mentors will report any suspicions of abuse to the Camp Director or Program Director.
9.    Pursuant to the California Penal Code Section 290.4, a full name and address, date of birth, driver’s license copy
      or ID number and Social Security number must be filed by each volunteer mentor for purposes of criminal
      background check. Information offered must be truthful and correct.
10.   Mentors will not exchange addresses or phone numbers with the participants, and they will not have any
      contact with the participants outside of the program.
11.   Unless a participant reports to you a case of abuse, any discussion with the youth must be considered
      confidential. Do not discuss the personal details of a participant’s life in any specific terms with parties not
      associated with the program.
12.   Camp Max Straus will not be held responsible for loss of or damage to personal property.
13.   Volunteers shall give Program Director or Coaches any ideas or recommendations for future programs.
14.   Material assigned to volunteers for use in camp shall remain in camp unless given as a gift by the camp program.

I have read the Sports Buddies & Arts Buddies Mentor Agreement and I will follow the guidelines. I shall
volunteer my time as a mentor and offer my full support to the participants, the program, and its directors.

Signature:                                                                   Date:


                                              HOLD HARMLESS CLAUSE:
 I,                                            will indemnify, save harmless, and defend Jewish Big Brothers Big

  Sisters of Los Angeles and Camp Max Straus from any liability from loss, damage or injury to persons or property
 in any manner arising out of or incident to the performance of this agreement, to wit: for the Sports Buddies & Arts
 Buddies Season, January 1 through March 31, 2007 at Camp Max Straus, located in Glendale, California.

 Signature:                                                                   Date:

				
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