Camp Mariposa Mentor Application

CM
Thank you for your interest in serving as a new mentor or continuing your mentoring role with Camp Mariposa®! Mentors are an incredible asset to the Camp Mariposa program. Mentors form important bonds, serve as positive role models, and provide support to campers. 

Camp Mariposa is a year-round addiction prevention and mentoring program for youth 9-12 affected by the substance use disorder of a family member. Camp Mariposa follows a group and peer mentoring model, meaning that all activities are held with other youth and mentors present. All youth and mentors make a one-year commitment to the program by attending at least four camps and additional activities.   

For more information, on Camp Mariposa visit our website or reach out to your local Camp Mariposa Program Director.
Please carefully review the application instructions and requirements before completing the application.   

Applicant Requirements

  • The applicant MUST be 18 years of age or older. 
  • The applicant is required to pass a criminal background check. 
  • The applicant is required to make a one-year commitment to attend at least four camp weekends a year and additional activities.

Application Instructions 
  • The mentor application will take approximately 10-20 minutes to complete.
  • Once you fill out your online application, you will receive a verification email from Camp Mariposa. The email will include details on the next step to verify your signature and submit your application. If the email is not in your inbox, please check your Spam folder. 
  • For information on how we collect, use, share and otherwise process information about you, please see our Privacy Policy. 
Screening Process
  1. Submission of the following online application which includes providing at least two references for new mentors.
  2. Complete screening and criminal background check.
  3. Participate in a phone/in-person interview.
  4. Attend and participate in required mentor trainings each year.
Commitment

Please check acknowledging that you have read and understand the commitment to become a mentor.

Applicant Information





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References

Camp Mariposa requires at least two references for all applicants. One reference must be a professional reference and the additional reference(s) can be personal or professional. The CM Program Director may contact one or all references as part of the screening process.
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CAMP MARIPOSA® PHOTO, PUBLICITY AND LIABILITY CONSENT AND RELEASE
(print name of adult participant)
understand that Eluna desires to use certain audio or visual works in which  I and/or my child or any child under my care, including without limitation to individuals identified in the “Youth Participant Information” section below (collectively, “Children”) might appear (e.g. video or photographs) and certain information about my Children or me, in connection with my participation, or the participation of my Children in Camp Mariposa® as a camper, junior counselor, alumni, youth family member, employee, volunteer or visitor.  I understand these audio or visual works may be used to advertise, promote, distribute, market, research, obtain funding for and sell various services, including Camp Mariposa and its related activities.  I also understand that, as part of my or my Children’s participation in Camp Mariposa, I or my Children may be exposed to or experience Harm (defined below), including as a result of infection by COVID-19 (also known as SARS-CoV-2 or the coronavirus) (“COVID 19”). By this Consent and Release Agreement (“Consent and Release”), I hereby grant certain rights to Eluna and release Eluna from certain liabilities, on behalf of myself (if I am a camper, employee, volunteer or visitor) or on behalf of my Children (if I am the parent, guardian, or caretaker of a minor camper, junior counselor, alumni or youth family member, employee, volunteer or visitor).  This Consent and Release confirms my Children’s and my grant of rights and our agreement is as follows:
1. Grant of Rights.  
For good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, I, on behalf of myself and my Children, hereby grant to Eluna and its directors, officers, employees, agents, representatives, contractors, successors, and assigns the perpetual, irrevocable, royalty-free, non-exclusive, worldwide, sublicensable right and license to: (a) use, edit, reproduce, modify, portray, publish, copy, distribute, create derivative works from, publicly perform and display without restriction all or portions of my or my Children's identity and my or my Children’s experience at Camp Mariposa, including without limitation my or my Children’s name, fictional names (if any), voice, signature, photograph, words, image, personality or other likeness of me or my Children, and any audio and video recordings of me or my Children or remarks and statements made by me or my Children (“Images and Remarks”); and, (b) create other materials or copyright-protected works using or incorporating my or my Children's Images and Remarks in any form or manner, including in any electronic or non-electronic medium now known or later devised, in connection with Camp Mariposa for advertising, distribution, marketing, promotion, publicity, research, reporting or any other lawful purpose (“Promotional Materials”). I understand that this Consent and Release will cover all of my or my Children’s future participation at any Camp Mariposa activities.

I waive any of my or my Children's right to own, inspect, approve or receive any payment or attribution with respect to any works or Promotional Materials using my or my Children's Images and Remarks, any accompanying written copy or printed matter, or the use to which it is applied.  I understand and agree that the Images and Remarks, and Promotional Materials containing or based on my or my Children's Images and Remarks may be used without any restriction as to changes or alterations, and may be modified, used in derivative works, distorted, included in composites or otherwise used in unexpected contexts, manners, or forms, or may not be used at all, and I grant Eluna all necessary rights to do the foregoing.  To the extent moral rights in my or my Children's Images and Remarks or any Promotional Materials may not lawfully be waived, I hereby agree not to bring any actions or claims against Eluna therefor.

2.  Contact.  Unless I opt out below, I agree to receive information/news/updates and other communications in hard copy, via electronic delivery, via telephone and other means from Eluna.  I hereby consent to collection and disclosure of my mailing address, email address and phone number to Eluna for such purposes, unless I opt out below.

3.  Release.  
I, on behalf of myself and my Children, hereby fully and forever release, discharge, and agree to indemnify, defend and hold harmless Eluna and its directors, officers, employees and advisors (collectively, the “Released Parties”) from any and all claims, demands, causes of action, damages (including without limitation direct, indirect, incidental, consequential, special or punitive damages), losses, expenses and liabilities (whether under contractor, warranty or tort, including negligence (whether active, passive, or imputed)) relating to any claim that my Children or I may have, now or in the future, based on: (a) any usage or adaptation, whether intentional or unintentional, of my or my Children's Images and Remarks or portions thereof, or works or materials derived therefrom including, but not limited to, claims for libel, defamation, invasion of privacy or rights of publicity, infringement or violation of moral rights or any other right arising out of, or relating to, any use of my or my Children's Images and Remarks, including by virtue of any blurring, distortion, alteration, optical illusion, or use in composite form, whether intentional or otherwise, or based upon any failure or omission to make use thereof; or (b) death, personal injury, property damage, pecuniary or other loss, damage, cost or expense (collectively, “Harm”) that may be suffered by my Children, me or any third party as a result of, or in connection with, my or my Children's participation in, volunteering for, or employment by Camp Mariposa, including any Harm or infection caused by exposure to COVID-19 that I or my Children may experience by attending Camp Mariposa activities. Camp Mariposa and Eluna cannot guarantee that you/you and your Children will not become infected with COVID-19. Further, attending Camp Mariposa activities could increase your risk and your Children’s risk of contracting COVID-19. By signing this Consent and Release, I understand the contagious nature of COVID-19 and voluntarily assume the risk that I or my Children and I may be exposed to or infected by COVID-19 by attending Camp Mariposa activities, and that such exposure or infection may result in personal injury, illness, permanent disability, or death. I understand that the risk of becoming exposed to or infected by COVID-19 at Camp Mariposa activities may result from the actions, omissions, or negligence of myself and/or others, including, but not limited to, Eluna, Camp Mariposa and their respective directors, officers, employees, agents, volunteers, or program participants and their families. I understand that this waiver will cover all of my or my Children’s future participation at any Camp Mariposa activities. I voluntarily assume all of the foregoing risks and accept sole responsibility for any illness or injury to myself/to myself and my Children, including, but not limited to, personal injury, disability, and death, damage, loss, claim, liability, or expense, of any kind, that I or my Children may experience or incur in connection with my or my Children’s attendance at or participation in Camp Mariposa activities.  I AGREE TO INDEMNIFY AND HOLD HARMLESS EACH OF THE RELEASED PARTIES FROM AND AGAINST ANY AND ALL CLAIMS, COSTS, LOSSES, DAMAGES AND EXPENSES (INCLUDING REASONABLE ATTORNEYS' FEES) INCURRED BY ANY RELEASED PARTY ARISING OUT OF OR IN CONNECTION WITH ANY HARM OR RELEASED CLAIMS. If any provision of this Release is held to be invalid or unenforceable, then that provision shall be severed, and all remaining provisions shall be given full force and effect.

4.  Representations and Warranties.  I represent and warrant that: (a) my or my Children’s involvement or participation in Camp Mariposa is voluntary, (b) I understand that there is a risk of danger, bodily harm, injury, emotional stress, or death as a result of my or my Children’s participation in, volunteering for, or employment by Camp Mariposa, (c) I further understand that there is the potential for risks and dangers that may not be obvious or reasonably foreseeable at this time related to my or my Children’s participation in, volunteering for, or employment by Camp Mariposa, and (d) I voluntarily, on behalf of myself or my Children, assume the risks, including, but not limited to, those outlined in items (b) and (c) above.  I further represent and warrant that I have the power, capacity and authority to grant the rights to Eluna herein granted, that this Consent and Release constitutes my or my Children's legal and binding obligation enforceable in accordance with its terms and that the grants of rights or any portions thereof will not conflict with any similar grants of rights agreements I or my Children have made.

5.  Binding Agreement.  This Consent and Release expresses the entire understanding between Eluna, me and my Children, and supersedes any prior agreements and discussions between us with respect to the subject matter of this Consent and Release.  In granting the rights herein, neither I nor my Children have been coerced or induced to do so by any representations or assurances by Eluna or its agents or representatives.  This Consent and Release may be amended only by written instrument signed by Eluna and me.  The provisions hereof shall be binding upon me, my Children and my heirs, representatives, executors, administrators, and successors.  Eluna may, in its sole discretion, assign or transfer some or all of this Consent and Release.  

6.  Governing Law.  This Consent and Release will be governed by the laws of the State of Pennsylvania, without regard to its choice of law principles.  The parties hereby submit to the exclusive venue and jurisdiction of the state and federal courts of Philadelphia County, Pennsylvania and waive any objection thereto (irrespective of whether the individual signing this Consent and Release changes his or her state of residence).   

7.  Severability.  If any provision of this Consent and Release Agreement is found to be unenforceable in any respect by a court of competent jurisdiction, this Consent and Release Agreement will nonetheless be enforced to the maximum extent to which it is found to be legally enforceable.  
  
BY SIGNATURE BELOW, I AGREE AND ACKNOWLEDGE THAT I HAVE READ, UNDERSTOOD, AND ACCEPTED THIS CONSENT AND RELEASE; THAT THE PROVISIONS CONTAINED HEREIN REPRESENT AN AGREED ALLOCATION OF RISKS WHICH ELUNA IS RELYING UPON; THAT I HAVE SIGNED THIS CONSENT AND RELEASE VOLUNTARILY AND OF MY OWN FREE WILL; AND THAT I HAVE HAD AMPLE OPPORTUNITY TO ASK QUESTIONS REGARDING THE TERMS AND CONDITIONS OF THIS CONSENT AND RELEASE.

Agreed and Accepted:  Participant




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