Adult Volunteer Application

Adult Staff Questionnaire

Thank you for applying to serve at Pleasant Valley Christian Camp! Please answer all questions below.
Application Date*

MonthDayYear
Date
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*

Confirmation Emailexample@example.com
Phone Number*

Area CodePhone Number
Gender:*

MaleFemale
Birth Date*

MonthDayYear
Date
T-Shirt Size (Adult)*

XSSMLXLXXLXXXL
At which camp(s) are you interested in serving?*

Winter Junior RetreatServe WeekendFirst Chance CampJunior CampMiddle School CampHigh School CampFamily CampWomen's RetreatYoung At Heart RetreatRental GroupsGeneral/off-seasonOther
Which position(s) are you interested in?*

CounselorMusic/WorshipSpeakerActivities/recreationCamp nurseLifeguardKitchen/food serviceHousekeepingGrounds/maintenanceCheck-in/office supportOther
Please select any of the following certifications, licenses, or other training you have:*

CPR/first aidLifeguard certificationRN licenseFood handler's permitNone of theseOther
Please select any of the following skills or interests that you have:

CraftsTeaching/preachingSkits/dramaVideo/photographyGuitarPianoDrums/rhythmSingingLeading sports and field gamesHikingOther
Please provide a personal reference who can tell us more about you. List first and last name, phone number, and email address.*
Do you consider yourself to be a Christian? Please describe what that means to you.*
In the last year, how has God revealed Himself in your life?*
In what areas are you seeking to grow in your faith and/or personal development?*
In what ways can we be praying for you and encouraging you?*
Please provide the name of your pastor and the church you attend. Include a contact phone number.*
Please list any experience you have working with children. Include the positions, organization names, contact names, and phone numbers.*
Please list any allergies to food, medications, or environment that you would like us to know about. Please note that this information will be shared with the program directors, camp nurse, and food service director.*
Please list any medical conditions that you would like us to know about. Please note that this information will be shared with the program directors, camp nurse, and food service director.*
Permission to Treat: I hereby give permission to medical personnel to provide me with health care and emergency treatment, including, but not limited to, X-rays, routine tests and treatment and/or hospitalization; and to provide or arrange necessary related transportation. I also agree to the release of any records necessary for treatment, referral, billing or insurance purposes.*

YesNo
Photo Release: I hereby grant permission to be video taped and/or photographed while participating in programs and activities of Pleasant Valley Christian Camp. I Understand that video taping and photographs will be used for educational, training and promotional purposes only.*

YesNo
Screening Questionaire

Because Pleasant Valley Christian Camp desires to protect the children in our care, please answer the following questions. We understand that the answers to these questions may be private and deeply personal and we will protect your privacy.
Why do you want to work with children in this ministry?*
Do you have a preference concerning the age and/or gender of children with whom you work?*
Have you ever abused a child physically or sexually?*

NoYes
Have you ever been accused of abusing a child physically or sexually?*

NoYes
I authorize Pleasant Valley Christian Camp to contact all individuals, organizations, and references listed on this application form to verify the information I have provided. I agree to release from liability any person or organization that provides information concerning me, including those persons I have listed as references and contacts from my previous work with children. **Please Type your name and today's date to sign your application.***
Should be Empty:

Adult Staff Questionnaire