Volunteer Counselor Re-Application

"*" indicates required fields

ATTENTION POTENTIAL COUNSELORS! Please complete this form. Also read the Pastoral Reference Form carefully and follow the instructions. (We will not process your application until the pastor reference form is received.)

Name*

First Middle Last

Address

Street City State ZIP Code

Phone Number

Email Address*

Date of Birth

Church You Attend

Pastor

Phone Number

PLEASE CHECK THE CAMP(S) YOU ARE ELIGIBLE FOR AND INTERESTED IN COUNSELING AT*

Explorers (ages 8-9)

Pathfinders (ages 10-11)

Adventurers (ages 11-12)

Junior High (ages 12-14)

Senior High (ages 15-18)

The camp policy for counselors is that you need to be 16 years old or older and you must be 4 years older than the campers you are counseling. NOTE: SHOULD COUNSELOR OR CAMPER DISMISSAL BE CONSIDERED, THE DIRECTOR, CAMP PASTOR, LEAD COUNSELORS, AND ADMINISTRATOR WILL CONFER BEFORE ACTION IS TAKEN.

What has the Lord taught you or challenged you with in your Christian walk within the last several months?

Where are you presently attending church?

Name of Church

Located

Please list two references that the camp can contact.

Name	Address	Phone	Actions

There are no References.

Applicant’s Statement

The information contained in this application is correct to the best of my knowledge. I authorize any references or churches listed in this application to give any information (including opinions) that they may have regarding my character and fitness of children or youth work. In consideration of the receipt and evaluation of this application by Crystal Springs Camp, I hereby release any individual, church, organization, charity, employer, reference, or any other person or organization, including record custodians, both collectively or individually, from any liability for damages of whatever kind or nature which may at any time result to me, my heirs, my family, on account of compliance or any attempts to comply, with this authorization. I waive any right that I may have to inspect any information provided about me by any person or organization identified by me in this application. Should my application be accepted, I agree to be bound by the policies of Crystal Springs Camp, and to refrain from unscriptural conduct in performance of my services on behalf of the camp. I realize and agree that any photos or recordings taken of me during the summer may be used in camp promotional material. I further understand that Crystal Springs Camp will thoroughly pursue the safety of minors being served by their ministries. To that end, they may check my name against the list of registered sex offenders in the United States and a background check. I further state that I HAVE CAREFULLY READ THE FOREGOING RELEASE AND KNOW THE CONTENTS THEREOF AND I SIGN THIS RELEASE AS MY OWN FREE ACT. This is a legally binding agreement which I have read and understand.

Applicant's Signature*

Signature Date*

Primary Screening Form for Crystal Springs Camp

This is to be completed by all applicants for any position (volunteer or compensated) involving the supervision or custody of minors. This is not an employment application form, but rather an instrument to help implement a safe and secure environment for our children and youth ministries. This is a confidential form and the information herein will be accessible only to the leadership team of Crystal Springs Camp.

PERSONAL INFORMATION

Name*

First Last

Personal Information Date*

Social Security #*

Address*

State ZIP Code

Home Phone*

Date of Birth*

Have you ever been charged or convicted of a felony?

Yes

Have you ever been charged or convicted of any misdemeanor of sexual nature?

Yes

If yes to either of the above two questions, please explain

Comments

This field is for validation purposes and should be left unchanged.

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