First Name:

Last Name:

Gender

Female Male

Birth date:

 (mm/dd/yyyy)

Address:

City:

Province:

Postal Code:

Home Phone:

Work Phone:

Cell Phone:

Email:

Marital Status:

Single Married Divorced Widow/Widower Separated Remarried

Have you served at Camp before?  If so, what year?

I would like to work in wk #:

1: Jun 30-Jul 7 2: Jul 7-14 3: Jul 14-21 4: Jul 21-28 5: Jul 28-Aug 4 6: Aug 4-11 7: Aug 11-18 8: Aug 18-25

Position (select all that you are interested in:) (CTRL+Click to select multiple.)

Audio/Video Counsellor Head Cook Trainee (min age 17) Housekeeper Kitchen Assistant Medical (credential required) Maintenance Program Leader

I have interest/skill in: (CTRL+Click to select multiple.)

Archery Bible Study Handcrafts Sports Riflery Music Other

if Music or other, please specify

Grade Completed:

Post-Secondary School and Education:

Job background:

First Aid Training:

If so, level and expire date:

Specify any courses/training/hobbies/interests/skills you have that are related to Camping.

Health Care Number:

Blood Type:

Last tetanus shot:

Any allergies:

Camp programs are very active. List medical/physical/emotional disorders that would affect your participation

List name and dosage of medications you will bring to camp

Name:

Relationship:

Home Phone:

Work Phone:

Name:

Relationship:

Home Phone:

Work Phone:

When did you become a Christian:

How did you come to know Jesus Christ as your personal Savior, and describe your present spiritual growth?

Indicate your past 5 year Church history below.
Do you regularly attend church (2 or more services per month)?

Church:

Address:

Phone:

Dates:

Church:

Address:

Phone:

Dates:

Church:

Address:

Phone:

Dates

List your specific church ministry involvement:

(A copy of the blank Camp Chamisall Personal Reference letter will be supplied if it is needed to update our records)

2 reference names below are required. If a personal reference form is required we will let you know. You should send it to ONLY ONE of them. It is your responsibility to get it to the individual. The reference form will be sent to you. Select someone who knows your spiritual background. We will contact the 2nd reference if we need more information. You may NOT use a relative as a reference and if possible the 2nd reference should be someone from outside your church.
CIT’s: One of your references MUST be your Youth Pastor/Sponsor.
 

Name:

Relationship:

Home Phone:

Work Phone:

Name:

Relationship:

Home Phone:

Work Phone:

Is there any additional information the Camp should know that may equip or hinder your productive ministry with children?

Have you been convicted for using or selling illegal drugs?

Have you been hospitalized or treated for alcohol or substance abuse?

Have you been convicted of a criminal offense (minor traffic violations excluded)?

Have you been accused, arrested, or convicted of any sexually related crime?

Have you been accused, arrested or convicted of any abuse related crime?

Are there circumstances in your life that would call into question your ability to work with children?