Mission 2:10 Volunteer Application (Brian/Week One)

Mission 2:10 Volunteer Application

All information is held strictly confidential. This form must be completely filled out. The information is vital to your acceptance and possible placement as a volunteer.
Full Legal Name*

First NameMiddle NameLast Name
This is my first time to serve at Mission 2:10I am a returning Staff or Camp Counselor
MaleFemale
Current Age*
Marital Status*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail*

Confirmation Email
Phone Number: Best one to contact you*

Area CodePhone Number
Emergency Contact*
Relationship *
Phone (Emergency Contact)*
Adult SmallAdult MediumAdult LargeAdult X-LargeAdult XX-Large
CPRFirst AidLife GuardNurseEMTCounseling or Therapy
YesNo
If yes, in what way?
YesNoYes, but I would prefer to discuss this in person
If yes, please clarify
Please describe why you wish to be a part of Mission 2:10
NoYes
If yes, please describe:
Personal Profile
NoYes
Where & When:
What church do you presently attend?*
For how long?
Pastor's Name*
Please describe any previous experience working with teenagers:*
Please describe any previous experience working with children who have been abused or neglected:*
NoYes
List five (5) strengths you have in working with children: Please be specific*
List five (5) weaknesses you have in working with children: Please be specific*

Following Rules: How well do you follow rules and respond to authority

	1	2	3	4	5

1 is Very Well, 5 is Poorly

Criminal Background

If your records have been expunged pursuant to applicable law, you are not required to answer yes to the following questions. If you are unsure whether to answer yes, we strongly suggest that you answer yes and fully disclose all incidents to avoid any future risk of embarrassment upon disclosure.
NoYes
NoYes
NoYes
NoYes
NoYes
If yes to any above, please explain:*
Print Name*
Signature*
Thank you for your interest in being a part of Mission 2:10 Camp!
Should be Empty:

Personal Profile