Summer Camp Staff

Applicant's Name *

First Name

Last Name

Newsletter

Please add my name to the mailing list for the quarterly newsletter, CMMBC News

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone 1 *

(###)

###

####

Phone 2

(###)

###

####

Pastor's Name

First Name

Last Name

Gender *

Male

Female

Are you Under the age of 18? *

Yes

No

Parent/Guardain Name

First Name

Last Name

Parent/Guardian Phone 1

(###)

###

####

Parent/Guardian Phone 2

(###)

###

####

Date of Birth

MM

DD

YYYY

Are you a Citizen of the United States?

Yes

No

Have you ever been charged, convicted of, pled guilty to a crime, either a misdemeanor or a felony?

Yes

No

Have you ever been charged or arrested for child abuse or contributing to the delinquency of a minor?

Yes

No

Do we have your permission to complete a criminal background check?

Yes

No

Do you have any physical or emotional conditions limiting your ability to perform as camp staff? *

Yes

No

Type of Position *

I am applying for a paid position

I am applying for a volunteer position

I want to exchange service hours to pay my camp fees.

Position Applying for *

Check all you are interested in

Camp Counselor (at least 1 year beyond high school graduation)

Camp Jr. Counselor (high school graduate)

Junior Staff (still in high school)

Food Service Worker

Camp Nurse

Camp Speaker

Music Director

Crafts Director

Games Director

Summer Camp Worship Intern

Summer Program Intern

Summer Food Service Intern

Splash Pad Operator

Other

Camps Applying for *

Check all that apply

Senior Camp (Upcoming grades 8-12 & recently graduated Seniors)

Trailblazers (Upcoming grades 4-7)

Pathfinder (Upcoming grades K-5)

Arts Camp (Upcoming grades 2-6)

Bicycle Camp (if available)

Soccer Camp (if available)

8-week internship

Other

Interests or Abilities

Please check any of the following statements that describe an interest or ability that you possess:

I have experience leading a small group and/or Bible study.

I am actively involved in a small group and/or Bible study.

I enjoy writing and/or performing creative skits for groups.

I enjoy singing as a member of a music team.

I enjoy playing _______ (list musical instruments below) as a member of a music team.

I can organize and lead groups to complete a craft or creative project.

I enjoy outdoor experiences, like hiking and camping.

I enjoy team sports like _______(list sports below)

I enjoy designing and participating in creative and fun games, like obstacle courses.

I am experienced with cooking or baking for more than 4 people.

Name *

First Name

Last Name

Gender *

Male

Female

Date of Birth *

MM

DD

YYYY

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Camps Applied for *

Soccer Camp (Upcoming grades K-8)

Pathfinders (Upcoming grades K-5)

Trailblazers (Upcoming grades 4-6)

Senior Camp (Upcoming grades -12 & recently graduated Seniors)

Arts Camp (Upcoming grades 2-6

Bicycle Camp (If available)

Summer Internship

Name 1

First Name

Last Name

Phone 1

(###)

###

####

Phone 2

(###)

###

####

Name 2

First Name

Last Name

Phone 1

(###)

###

####

Phone 2

(###)

###

####

Name *

First Name

Last Name

Phone 1 *

(###)

###

####

Phone 2 *

(###)

###

####

Doctor's Name *

First Name

Last Name

Doctor's Phone *

(###)

###

####

Health History

If the answer to any of these questions is "yes", please check the box in front of the condition and provide additional information as appropriate below

Diabetes

Seizures

Allergies

Allergy Shots (desensitization)

Glasses

Contact Lenses

For Fever/Pain

Acetaminophen (Tylenol)

Ibuprofen (Advil)

For Stomach

Calcium Antacid Tablets (i.e. Tums)

Bismuth Subsalicylate (Pepto Bismol)

Loperamide (Immodium)

For Topical Treatment

Antibiotic Ointment

Burn Ointment

Calamine Lotion

Hydrocortisone Cream

Sting Eze for insect bites

Chloraseptic Spray

Cough Drops

Parent/Legal Guardian Authorization (If under the age of 18)

My signature below indicates that the above named volunteer has permission to engage in all camp activities (unless noted otherwise) on and off camp grounds, and to be transported to and participate in, excursions off camp grounds (including swimming), under the supervision of CMMBC staff. I understand that staff members are expected to comply with camp rules, and anyone disregarding camp rules is subject to being sent home. I give permission for the CMMBC staff to: (1) provide routine health care (including medication) for the above named volunteer. I understand all medications, including over-the-counter, must be kept by the nurse during summer camps. If deemed necessary, I authorize them to obtain services of medical professionals and to provide necessary related transportation. I authorize any physician and any hospital, through its medical staff, to take appropriate measures. I understand that I am responsible to pay for my child's medical care, including any emergency care authorized in this section. I agree to the release of these records for insurance purposes and/or as requested by a physician for the care of my minor child. The camp will make reasonable efforts to notify parents promptly if measures other than routine care are taken. (2) photograph and record this staff member and to use his/her images or sound prints in promotional materials for CMMBC. (3) use of a photocopy of this form as my authorization

First Name

Last Name

Staff/Volunteer Agreement - E-Signature I understand the importance of, and will adhere to camp safety regulations and the directions given to me by camp leaders so they can provide me and all campers with a safe, pleasant and memorable camp experience. I will be sure to give all medications to the nurse during camp. I understand that if I fail to follow camp rules, I may be sent home. *

First Name

Last Name