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First name
Last name
Address
Phone
Email
Birthday
Year
Month
Month
Day
Grade in September 2024 (if applicable)
Home Church
Pastor or Youth Pastor who will be your Pastoral Reference
Email of Pastor
Emergency Contact Name
Emergency Contact Number
If over 18, I have included a police reference check
Yes
No
I am under 18
Attach the Police Reference Check
Upload File
Which group(s) would you like to (and are available to) work with?
Youth Camp (Grade 9-12)
Junior High Camp (Grade 6-8)
Junior Camp (Grade 4-6)
Please describe your Christian experience and your present relationship with Jesus Christ.
Please describe why you want to counsel at camp.
Please describe your present relationship with your local church, include areas of service.
Do you have any additional qualifications? (First Aid, CPR, Lifeguard etc.)
Please list any medical concerns
Submit
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