KidSHINE Volunteer Intern Application

Thank you so much for your interest in an internship at KidSHINE! We love having students and volunteers join us, as they are an integral part of making the KidSHINE experience special.

Please fill out the following form. Once we have received your form we can move forward in scheduling a time to meet and see if an internship with KidSHINE is a good fit for you and our clinic.

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Name

First

Last

Phone

Resume

Click or drag a file to this area to upload.

Address

Address Line 1

Address Line 2

City

State

Zip Code

Date of Birth

mm/dd/yyyy

Do you have transportation?:

Start Date/ Term of Internship:

# of Hours Required:

Days/ Times Available to Volunteer:

School/ Level of Schooling:

Emergency Contact: (Name, Relation, Phone #)

How did you hear about KidSHINE, and why are you interested in an internship at KidSHINE?

Tell us about the qualities, experiences and skills that you possess that make you a candidate for this internship.

What are 2-3 goals that you have for yourself while volunteering at KidSHINE (that you would like to take away from this experience)?

May we use your name, picture, and other info on the KidSHINE website and Facebook/ Instagram pages?

Yes
No
Other

Our Bootcamp Program and Vacation/ Summer Camps wouldn't be successful without our amazing interns. We are looking for volunteers who are committed for specific periods of time. Which of the following applies to you?

I can commit to an 8-week Bootcamp session
I can commit to a Summer internship
I can commit to a Semester internship
I can commit to a week of Vacation/Summer camps (Ex: April Vacation Week)
Other

Please sign below that you understand the following: I understand that I am committing to assist for a specified period of time, with children who may form bonds quickly. I know that this is a learning experience for me and also a special connection for the children I am supporting. If I am unable to make it to the time (class, hours, camps, etc.) I assist with, I will text my supervisor with 24 hours notice to ensure she has coverage. I will also keep track of my own hours if I need volunteer hours recorded/ signed off on, or if I need a recommendation, and it is my responsibility to provide this information to my supervisor ensuring adequate time to provide a response. I also understand that KidSHINE is primarily a medical facility and all information about clients (name, age, diagnosis) is HIPAA (privacy) protected.

Date / Time

Date

Time

Emily B.

OT, MS, OTR

Emily is a licensed and registered Occupational Therapist who received her master’s degree in Occupational Therapy in 2022, from American International College in Springfield, MA. She gained clinical experience working with children with ADD, ADHD, SPD, ASD, and a variety of other diagnoses. She has her bachelor’s degree in exercise physiology and considers fitness a passion. Emily is enthusiastic about incorporating the use of therapeutic exercise and movement in her treatment sessions to help bring confidence and success to children and their families.

In her free time, Emily enjoys exercising, playing with her dog, hiking, and spending time with friends and family.

KidSHINE Volunteer Intern Application

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