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- Select Registration Type*
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- Applicant Gender*
- Applicant Date of Birth*
- Applicant is less than 18 years of age by July 19th, 2026
- Applicant American Sign Language Fluency
- Applicant Superpower
- Applicant Marital Status
- Does Applicant attend church?
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Format: (000) 000-0000.
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Format: (000) 000-0000.
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Format: (000) 000-0000.
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Format: (000) 000-0000.
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Format: (000) 000-0000.
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Format: (000) 000-0000.
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- As Parent/Guardian, I give permission for the Applicant to be photographed during camp. The photos are shown during meals, camp blog and social media.*
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- Applicant agrees with this Statement of Faith*
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- Personal Reference is the same as last year?
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Format: (000) 000-0000.
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Format: (000) 000-0000.
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Format: (000) 000-0000.
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- Pastor Reference is the same as last year?
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Format: (000) 000-0000.
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Format: (000) 000-0000.
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- Applicant's first time attending NWCCD as Staff or LIT?
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- Do you use illegal drugs?
- Do you drink alcoholic beverages?
- Have you ever been convicted of a criminal offense?
- Have you ever been charged with child neglect or abuse?
- Have you ever been charged with a sex-related crime?
- Have you ever been charged with a crime by violence?
- Have you ever been charged with threat by violence?
- Has your driver's license ever been suspended or revoked?
- Do you use tobacco?
- Are you in a sexual relationship outside of marriage?
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- Are you a Christian?*
- You have filled out your Christian Life Experience before and no information has changed.*
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- If you are on staff, we want you to serve in an area that uses your talents, gifts, and interests. Please help us by checking any areas that interest you.
- Safety Information. Please check the following.
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- Applicant is permitted to engage in recreational activities such as running, swimming, competitive games and hiking
- Applicant is permitted to swim (there are lifeguards on duty at the beach)
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- Applicant has the following health conditions
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- Applicant requires the following for mobility
- Applicant has the following non-food allergies
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- Applicant has food or drink allergies*
- Applicant had surgical operations in the past 12 months
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- Applicant had a tetanus shot within 10 years
- Date of last Tetanus shot
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- Date
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- Emergency Contact #1 Superpower
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Format: (000) 000-0000.
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Format: (000) 000-0000.
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Format: (000) 000-0000.
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- Emergency Contact #2 Superpower*
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Format: (000) 000-0000.
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Format: (000) 000-0000.
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Format: (000) 000-0000.
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Format: (000) 000-0000.
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Format: (000) 000-0000.
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- Applicant has Medical Insurance that is valid in State of Oregon*
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Format: (000) 000-0000.
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- Applicant will bring prescription medication to camp*
- Applicant will bring over the counter medication to camp*
- Applicant has the following in their possession for emergencies
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- Parent/Guardian gives permission to Camp Nurse to dispense the following to the Applicant during camp
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- Date
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- Date
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- Applicant has Special Diet Needs for camp*
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- Should be Empty: