YMCA Camp Tockwogh 

Staff 2022 Info Form

All staff are required to complete this form ASAP by May 20th at the latest!

This form requires you to upload your vaccination card and health insurance (if applicable). Be sure to have these ready before you start this form.

In order for you to have the best experience this summer, we recommend full honesty and transparency on the following forms. We cannot help or accommodate for you if we are not aware of a need! 

All information provided is held in the strictest of confidence and shared only on a specific need-to-know basis with leadership staff or camp nurses.

If you have any questions or concerns, please email Pat at pgizinski@ymcade.org 

Your Name*
Pronouns (How do you like to be addressed?)*
Why is this important? https://www.umass.edu/stonewall/sites/default/files/pronouns_intro.pdf
Please list an email you check regularly!
Current Mailing Address*
Birthdate*
Gildan's Basic Cotton T-shirt - Unisex
If you do not have any dietary rescrictions, please write "None"

Health Information

Primary Care Physician / Your Doctor's Name - if you do not currently have a doctor, please leave blank
If you do not have any allergies, please write "None"
If you do not have any health concerns, please write "None"
If you do not have any limitations, please write "None"
If you do not know, please write "Unknown" - If you know that you've had one in the past 10 years but not the exact date, please write "Up to date"
If you believe you are up to date on all vaccines, please write "None" -- This information is required so we can notify you of any possible communicable disease outbreak you may be protected against.
Will you be taking any medications while at camp?*

STAFF MEDICATION POLICY: While you are at camp, medications will be held securely and confidentially by the camp nurses in the Wellness Center. Medications will be available for staff to self-administer at every meal (at the Wellness Outpost) or at any time (in the Wellness Center.) 

NO MEDICATIONS ARE ALLOWED IN THE CABINS.  This includes over-the-counter meds and vitamins. Exceptions apply for self-carry epi-pens and inhalers only. 

All standard over-the-counter meds (Advil, Tylenol, Zyrtec, etc.) are available for staff in as needed in the Wellness Center at sick call. 

Do you currently have health insurance?*
No File Chosen
File uploads may not work on some mobile devices.
No File Chosen
File uploads may not work on some mobile devices.
No File Chosen
File uploads may not work on some mobile devices.
If you do not currently have access to your health insurance card, please leave blank

COVID-19 Information

Have you previously tested positive for COVID-19?*
Have you received the COVID-19 vaccinations?*

We require all Tockwogh staff to be up to date on their vaccinations. Please email Pat for more details. pgizinksi@ymcade.org 

If you would still like to work with us, we will take you to receive your vaccinations during staff training week. 

No File Chosen
File uploads may not work on some mobile devices.

Emergency Contact

Emergency Contact Name*
Parent, guardian, friend, neighbor, etc

Camp Driver Certification

Will you be 21 years old or older by the summer?*
Do you have a valid driver's license?*

Internationals require a International Driver's License to be a "Camp Driver."  Being a Camp Driver allows you to use camp vehicles during work and request borrow camp vans on your time off. 

This is optional and may require you to pay a fee. Please visit https://internationaldrivingpermit.org/ to find the best way to apply for an international drivers license in your country. 

Personal Information

Do you plan on having virtual therapy sessions with your existing therapist/psychiatrist while at camp?*

Please note the best times to schedule virtual therapy sessions during the camp day:

  • 8:30am-10am
  • 1pm-2pm
  • 6pm-9pm

Times will need to be confirmed with your direct supervisor and the camp office (if using the office space/therapy room).

Please note that we are only able to appropriately accommodate for matters made known to us!
If you do not have any special accommodations, please write "None"
During staff training, we want to make sure you learn in the best way possible!

Getting to Camp

I am a....*
What is the status of your visa?*
When is/was your visa appointment scheduled for?*

Once you receive your visa, please email Pat at pgizinski@ymcade.org

Once your travel information is confirmed, you will need to complete the pick-up request form (at least 2-weeks prior to your arrival at camp!)

If you know your travel information now, please click here to complete the form: https://ymcade.formstack.com/forms/pick_up_request

Powered by Formstack Create your own form