Camp Crucis (VHC) Application

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Name

First Name Last Name

Birth Date

Date

School

Grade

Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Phone Number

Area Code Phone Number

Email

example@example.com

Parent or Guardian Name

First Name Last Name

Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Parent or Guardian Phone

Area Code Phone Number

Parent or Guardian Email

example@example.com

Please list and comment on any experiences (employment, volunteer, etc) you have had that will contribute to your role as a Horsemanship Counselor.

Describe the qualities of an "excellent" Horsemanship Counselor.

What specific qualities as a Horsemanship Counselor will you bring to share with your campers?

When we say that Camp Crucis is a "ministry", what does this mean to you?

Describe your experience as a camper at Camp Crucis (or other summer camp).

Describe your experience (if any) as a Volunteer Horsemanship Counselor, including the year(s).

Write briefly about a person who has had a significant impact on you spiritually and why.

Complete this sentence: Camp Crucis is _____

Diocese or Denomination

Name of Home Church

Home Church Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Name of Clergy or Pastor

Phone Number of Clergy or Pastor

Area Code Phone Number

I certify that the information provided on this form is correct. If I am chosen to serve as a Volunteer Horsemanship Counselor, I will uphold the high standards of personal conduct expected of me. I also pledge my commitment to the program and to the young people I will counsel and lead. I will obey the policies and rules of Camp Crucis. I understand that failure to comply with any of these requirements will automatically result in my dismissal. I agree to contact Camp Crucis if I am unable to serve at my assigned session.

Signature

Clear

Please check the sessions you are available to serve

Sr High 6/27-7/3 Family Camp 7/4-7/7 Pee Wees 7/11-7/16 Jr Confetti 7/18-7/23 Jr High 7/25-7/31

Parent or Guardian Permission (For applicants under 18 only)

If selected, my daughter/son has my permission to participate in the summer camp program at Camp Crucis as a Volunteer Horsemanship Counselor.

Parent or Guardian Signature

Clear

Date

Volunteers must have 2 reference forms from individuals not a part of the applicant's family, and 1 from a clergy member or pastor of their home church. The link to this form can be found here: Camp Crucis Reference Form Please forward the link to the people you want to fill out.

Horsemanship Counselor - Covenant

1. The physical, spiritual, and emotional safety and well-being of my campers is my FIRST priority.
2. I will remain with my campers AT ALL TIMES, unless relieved of their care by a Staff member.
3. I will take care of myself so that I can provide a great summer camp experience for my campers.
4. I will be a positive Camp Crucis Team Member in attitude and action.
5. I will strive to set an effective Christian example for my campers and my fellow VHC.
6. I pledge to abide by all policies and rules of Camp Crucis.
7. I will have to pass a background check and will be subject to random drug testing during counseling.

I understand these seven expectations and realize the Summer Camp Director, the Executive Camp Director, Equestrian Director, and the Spiritual Directors will hold me accountable in these seven areas. I further understand that failure to comply with this covenant will result in a meeting with the Leadership Team and the Camp Director to determine possible dismissal from my duties.

These are the expectations of you as a Volunteer Horsemanship Counselor (VHC). Your signature indicates your commitment to abide by this covenant.

Applicant Signature

Clear

Date

Training and Counseling Release

All Horsemanship Staff will be required to complete the “Ministry Safe” training. This is an online training program in sexual abuse awareness, for those who work with minors. The State of Texas also requires that we conduct a background check on all volunteers. While counseling, all employees and volunteers are subject to random drug testing. Your signature is approval for your child to attend this training program and to be subject to the requirements as outlined above.

Signature of Parent or Legal Guardian

Clear

Date

Health History

Name

First Name Last Name

Gender

SS#

Name of Parent or Guardian

First Name Last Name

Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Email

example@example.com

Phone Number

Area Code Phone Number

If parent or legal guardian is unavailable in an emergency, please notify:

First Name Last Name

Phone Number

Area Code Phone Number

Insurance Company

Policy #

Ins. Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Ins. Phone Number

Area Code Phone Number

Please attach a copy of both sides of your insurance card.

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Date of Last Exam by Physician

Date

Physician Name

First Name Last Name

Physician Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Physician Phone Number

Area Code Phone Number

Please list any allergies:

List any allergic responses to the above (e.g. requires Epinephrine):

Operations or any serious injuries (include dates):

Chronic or recurring illnesses:

Behavioral Disorders and Prescribed medication:

***Prescribed medications must be in an original pharmacy container with the correct name, date, instructions and physician's name on the label. A physician's signed note is needed to accompany any over-the-counter or sample medication.

MEDICATIONS being sent with counselor:

Are there any over-the-counter oral, topical, or instilled medications that the counselor cannot or should not receive should any minor symptoms develop?

Each swimmer recieves alcohol eardrops after each swim to aid in the prevention of swimmer's ear, unless otherwise instructed during registration.

PLEASE NOTIFY THE CAMP IF THIS COUNSELOR IS EXPOSED TO ANY COMMUNICABLE DISEASE DURING THE THREE WEEKS PRIOR TO CAMP ATTENDANCE.

This health history and immunization report is true and accurate to the best of my knowledge. In the event of an illness or emergency, I hereby give permission for the staff of Camp Crucis to authorize medical treatment of my child by a licensed healthcare professional. I understand that there is a certain degree of risk and possible injury by reason of the camp and its activities. I authorize the camp to administer over-the-counter drugs to my child as needed. I have read the information regarding insurance and acknowledge the extent of coverage.

Applicant Age 18+ or Parent or Legal Guardian

Clear

Date

Volunteer Horsemanship Counselor Application