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2011 SC COG Youth Camp Worker Application


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2011 SC COG Youth Camp Worker Application

  1. 1. You can join the ministry team by completing this application and mailing it to: Church of God Youth Camp Ministries PO Box 309 Mauldin, SC 29662
  2. 2. SOUTH CAROLINA CAMP STAFF APPLICATIONTo work in camp one must be a committed Christian at least 18 years of age. Senior Camp workers must be at least twenty. Inyounger camps, a limited number of teenagers, ages 16-17 may be accepted as a Counselor In Training or a Worker in Trainingproviding they are needed. Priority will be given to adult workers. Persons age 15 or younger need not apply. No worker shouldreport to camp without receiving official acceptance from the State Youth & Discipleship Department.Name__________________________________________________________ Male Female Married SingleEmail Address_______________________________________________________________________________________________ Please print clearlyComplete Address____________________________________________________________________________________________ Street City State ZipHow long have you lived at this address?___________________________ If less than two years, give previous address below:Previous Address_____________________________________________________________________________________________ Street City State ZipHome Phone # (___)________________ Work Phone # (___)___________________ Date of Birth _____/_____/_____ Age_____Place of Birth _______________________________________________________________________________________________ City State CountyEducational Background: (Enter highest year completed in appropriate space.) ___Elementary School (Grades 1-5) ___Middle School (Grades 6-8) ___High School (Grades 9-12) ___College (1-4) ___Graduate SchoolPresent Occupation: _______________________________________________ Employer: __________________________________Driver’s License #: _____________________________________ State __________ SSN: _________-____________-___________ **Picture ID will be required upon arrival at camp.Do you have any health problems or physical limitations? Yes No If yes, please explain:_______________________________________________________________________________________________________________________________________List any allergies you may have:_________________________________________________________________________________Name any medication you are taking:_____________________________________________________________________________Date of your last tetanus shot:___________________________________________________________________________________In case of an accident or a serious illness you have my permission to secure the proper medical treatment. (If under 18, parentalsignature is required.) Parent’s Signature______________________________________________________________Camp(s) I Would Like To WorkMauldin Camps Pee Dee Camps Discipleship Camp (ages 13-18) June 13-17 Mini (ages 6-9) July 5-8 Senior (ages 15-18) June 27 - July 1 Senior (ages 14-18) July 11-15 Mini (ages 6-9) July 5-8 Junior (ages 10 -13) July 18-22 Intermediate (ages 10-11) July 11-15 Junior (ages 12-14) July 18-22 COUNSELOR: A counselor is assigned to care for a STAFF: In addition to working in a specific area such asgroup of campers. Special qualities include: leadership and recreation or canteen, staff members are called upon to help wherevercommunication skills, a sense of humor, patience, and a a need arises. Staff must be flexible and maintain a positive seconddeep Christian commitment to love young people. Campers mile attitude.will be in your care 24 hours a day. Cafeteria Recreation Certified Lifeguard Nurse1. Will your child be a camper the same week you work? Canteen Go Cart Mechanic Special Activities Yes No If yes, do you want your child to be placed in your Other:________________________________________________ room? Yes No Does not matter Check only one:2. Will campers from your church be in your camp? Yes No I will reside at camp and bunk in the staff quarters. If yes, should they be placed in your room? I will work, but will provide my own quarters. Yes No Does not matter I will help during the day, but must drive home each night.
  3. 3. SOUTH CAROLINA CAMP STAFF APPLICATION (continued)Name of church you attend___________________________________________ Pastor____________________________________Spiritual Status: (Check appropriate spaces): Saved Sanctified Holy Ghost Baptism Baptized in Water Church MemberLocal Church Experience - List all positions and church work you have been involved in:Present: ____________________________________________________________________________________________________Past: _____________________________________________________________________________________________________________________________________________________________________________________________________List the names of other churches you have attended regularly during the past five years: ___________________________________________________________________________________________________________________________Have you worked previous years in South Carolina Church of God Youth Camps? Years: ______________________Capacity: ________________________________________________________________________________________I pledge to abide by all worker guidelines in both action and attitude, and dedicate myself to the success of camp. Yes NoI will be present and on time for Worker’s Orientation at 10:00 a.m. the day camp begins. I understand that campers arenot to arrive before check-in at 1:00 p.m. Therefore, I promise that another person will bring our campers so that I cangive my full attention to Orientation. Yes NoI understand that the Camp Insurance Policy provides secondary coverage, and I provide primary coverage. I acceptfinancial responsibility for medical costs beyond limits of camp policy stated here: Medical & Hospital $2500, Dental$300. Yes NoI have read and answered all the questions. I understand the importance of each statement. I give you my word. Signature_______________________________________________ Statement of ReservationWhile no one is rejected to work or attend Church of God Youth Camp on the basis of race, color, or creed, the StateDirector of Youth and Discipleship does reserve the right to accept or reject an application for volunteer work at Churchof God Youth Camps after review of said application reveals that the services of the applicant would or would not be inthe best interest and success of the camp. Applicant’s StatementThe information contained in this application is correct to the best of my knowledge. I authorize any references listed inthis application to give you any information (including opinions) that they may have regarding my character or fitness forchildren or youth work. In consideration of the receipt and evaluation of this application by the Church of God, I herebyrelease any individual, church, youth organization, charity, employer, reference, or any other person or organization,including record custodians, both collectively and individually, from any and all liability for damage of whatever kind ornature which may at any time result to me, my heirs, or 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 ororganization identified by me in this application.Should my application be accepted, I agree to be bound by the Bylaws and policies of the Church of God, and to refrainfrom unscriptural conduct in the performance of my services on behalf of the church.I further state that I HAVE CAREFULLY READ THE FOREGOING RELEASE AND KNOW THE CONTENTSTHEREOF AND I SIGN THIS RELEASE AS MY OWN FREE ACT. This is a legally binding agreement which I haveread and understand. Applicant’s Signature_________________________ Witness____________________________________Date_______________________________________ Date______________________________________
  4. 4. Addendum To Youth Camp Worker Application The following questions are placed here at the advice of our legal counsel. All questions must be answered. All responses are kept in strict confidence.1. Have you ever been charged, arrested, convicted or plead guilty to any crime? Yes No If yes, would you be willing to discuss this matter with a pastor or ministry leader? Yes No2. Have you ever been accused, charged, or alleged to have committed any act of neglecting, abusing, or molesting a child or youth? Yes No If yes, would you be willing to discuss this matter with a pastor or ministry leader? Yes No3. Have you ever been involved in homosexual activity? Yes No If yes, would you be willing to discuss this matter with a pastor or ministry leader? Yes No4. Have you ever been accused, charged or alleged to have committed a theft? Yes No5. Are you addicted to prescription drugs? Yes No6. Do you use tobacco in any form? Yes No7. Do you drink alcoholic beverages? Yes No8. Do you take illegal drugs? Yes No9. Do you have problems sleeping? Yes No10. Do you have recurring nightmares or sleep disturbances? Yes No11. Do you have a history of use of pornographic materials? Yes No12. Have you ever been charged with moving traffic violations? Yes No13. Has your driver’s license ever been revoked or suspended? Yes No PERSONAL CONSENT AND PERMISSION FORMBy signing below, you are granting permission for this application to be released by the state Youth & Discipleshipdirector to those he deems necessary in processing your application.“I certify to the best of my knowledge and ability, the information provided in this Application Form is true, correct, andcomplete. I authorize investigation of all statements contained in this application, including the conducting of a nationalcriminal background check. I release any and all parties from any and all liability for any damage that may result fromfurnishing such information to the Church of God.”Applicant’s Signature___________________________________________ Date__________________ Updated 3.31.2011