NCR Worker Application 2023

2023 - NCR CAMP WORKER Application General Requirements for Youth Camp Workers

Must be AT LEAST 18 years of age (21 for cabin leaders; persons 18 and under need not apply).

Must be a regular attendee of a local church

Must submit a completed application

Must have a confidential endorsement of your local pastor.

Those who are 18+ and are new applicants will be requested to authorize a background check If you have previously worked camp and it has been more than a year since you've had a background check, you will be requested to authorize one. Authorization emails are sent through Protect My Ministry/Mobilize My Ministry. Applicants are not required to provide information that is prohibited by Federal, State, or Local law. This application is given every consideration, but its receipt does not imply that the applicant has been accepted as a camp worker. Applicants are accepted on a "trial basis" and if in the judgment of the camp officials, it is found that the applicant/staff worker is not adaptable to the assignment and cannot be reassigned, or that information given has been misrepresented the acceptance of this application can be terminated without other cause or reason. in addition, an investigation will be made as to your character, general reputation, personal characteristics, and adaptability to the particular position to be assigned.

All applicants are required to undergo training and orientation provided by the State/Region Youth Director's office and under the supervision of the State/Region Youth Board.

Today's date

Date

Applicants Name

Applicant's Date of Birth

Date

Applicants email

example@example.com

Applicant’s Phone Number

Please enter a valid phone number.

Is Applicant Male or Female (Write below)

Applicant's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Name of Church Applicant Attends

Camp(s) you wish to work: (Please mark all that apply) Montana Camp is June 26-30, 2023; Dakotas Camp is August 7-11, 2023.

Montana Senior (Grades 6-12)Montana Junior (Grades 1st-5th)Dakotas Senior (Grades 6-12)Dakotas Junior (Grades 1st-5th)

Positions desired:*

Do you currently have a drivers license?

Shirt Size (Adult Sizes)

If yes. please list state and ID #

Please upload a copy of your Driver's License. Application is not complete without copy on file.

Personal Information:

Please read each question carefully and answer truthfully.

Have you ever been charged, arrested, convicted of, or pleaded guilty to any crime?

Have you ever been accused charged, or alleged to have committed any act of neglecting, abusing, or molesting a child or youth?

Have you ever been accused, charged or alleged to have committed theft?

Do you use tobacco in any form?

Do you drink alcoholic beverages?

Do you take illegal drugs or have an addiction to prescription medications?

Do you have problems sleeping, recurring nightmares, or sleep disturbances?

Do you have a history of use of pornographic materials?

Have you ever been charged with moving traffic violations?

Has your driver's license ever been revoked or suspended?

If yes. Where? How long?

If you answered "Yes" to any of these above, please explain.

List any physical limitations you feel need to be considered in your placement--if accepted

List any current medications

Do you carry any personal medical insurance? Please include a copy of your insurance card below--should we need to take you to the clinic or ER.

YesNo

Please upload a image of your insurance card here.

Do you have any food allergies?*

If you have food allergies, please list or explain below:

Emergency Contact in the case of an emergency, who should we contact?

Relationship to you: .

Phone Number of emergency contact

Please enter a valid phone number.

I have had sufficient opportunity to read and understand the entire document and its terms and conditions. I have read and understood it, and I agree to be bound by its terms. le Consideration of the services of the NCR (North Central Region), Executive Office, and their agents. owners, officers, volunteers, participants, any and all employees, and all other persons or entities acting in any capacity on their behalf thereinafter collectively referred to as hereby agree to release, indemnify and discharge NCR on behalf of my spouse, my children, my parents, my heirs, assign, personal representative, and estate as follows:

1. I acknowledge that outdoor adventure-based activities entail known and anticipated risks that could result: ie physical or emotional injury, paralysis, death, or damage to myself, to property, or to third parties. I understand that such risks simply cannot be eliminated without jeopardizing the essential qualities of the activity. The risks include, among other things This program is based on the "challenge by choice" principle. At any time you and/or your group are free to withdraw from participation in all other physical activities and its potential for slips and falls and falling rope burns; accidental drowning, pinches, scrapes, twists, and jolts that could result in scratches, bruising, sprains, lacerations, fractures, concussions, or stings, allergies, and associated diseases.

Furthermore, I understand that NCR employees and ALL Camp Staff have difficult jobs to perform. They seek safety first, but they are not infallible. They might be unaware of the participant's fitness or abilities. They might misjudge the weather or other environmental conditions. They may give incomplete warnings or instructions, and the equipment being used might malfunction.

2. I expressly agree to assume all of the risks existing in this activity my participation in this activity is purely voluntary and election to participate am fully aware of the risks

3. I hereby voluntarily release, forever discharge, and agree to indemnify and hold harmless NCR/Camp staff and employees from any and all claims, demands, or causes of action, which are in any way connected with my participation in this agreement.

4. I agree to indemnify and hold them harmless for all such fees and costs.

5. I certify that have insurance to cover any injury or damage may cause or suffer while participating or agree to bear the costs of such injury or damage myself. further, certify that assume the risk of any medical or physical conditions may have.

6. ln the event that my representative files a lawsuit against NCR. I agree to do so solely in the state of North Dakota or Montana (Depending on what Camp was attended), and further agree that if any portion of this agreement is found to be void or unenforceable, the remaining document shall remain in full force and effect.

7. By signing this document, I acknowledge that if anyone is hurt or property is damaged during my participation in this activity. I may be found by a court of law to have waived my right to maintain a Lawsuit against the NCR on the basis of any claims which have been released herein

By submitting an application to work at the camp, each minor worker agrees:

1. He/she will abide by all rules and operations of the camp.

2. The camp is privately operated camp and is not a public accommodation.

3. He/she will abide by all the teachings/tenets/practices of the Church of God.

4. Any violation of rules/regulations may result in the dismissal of the worker from the camp at the worker's expense, including transportation home.

5. His/her belongings, suitcases, backpacks, and all possessions, may be searched at any time by the camp administration.

6. Camp administration reserves the right to dismiss any worker for any reason, all in the sole discretion of the camp administration.

I have had sufficient opportunity to read this entire document. I have read and understood and agree to be bound by its terms.

Thereby giving my child permission to work and participate in NCR Church of God Youth Camp. I hereby waive, release, and discharge any and all claims, demands, and causes of action against Camp Officials, the Church of God in the North Central Region, and the International Offices of the Church of God. their agent(s), employees, and participants arising from any damages, property loss, or injury my child sustains at NCR Church of God Youth Camp. I further consent to allow Camp Officials to seek and obtain emergency medical or surgical treatment for my child should my child need medical treatment. I further grant permission for my child to appear in Camp videos and any promotional videos or photography, I fully understand that my family's insurance is the primary carrier for all accidents incurred at camp and the camp's insurance is the secondary carrier.

Please sign below...

Electronic Signature

List all previous church work involving youth. (List each organization's name and type of work performed and dates.) Additionally, list any gifts, training, education, or other factors which have prepared you to work Youth Camp.

Why did you decide to apply to work camp this year? Have you worked in previous years in NCR Camps? What years? Doing what?

Personal Reference, please do not list relatives.

First Name

Last Name

Phone Number

Please enter a valid phone number.

Release for Criminal Records Check:

I hereby consent for the State Youth Director's office to seek from local law enforcement any information which pertains to any record of conviction contained in its files or in any criminal file maintained on me whether local, or state. or national. hereby release Police Department from any and all liability resulting from such disclosure

Electronic Signature .

Applicant's Statement The information contained in this application is correct to the best of my knowledge. I authorize any references or churches listed in this application to give the NCR: Bishop, Youth Director, and Youth Board any information (including opinions) that they may have regarding my character and fitness for youth camp work le consideration of the receipt and evaluation of this application by the Church of God.

I hereby release to any individual, church, youth organization, charity, employer, reference or any other person of organization including record custodiam, both collectively and individually, from any and all liability for damages of whatever kind or nature which may at this time result to me, my heirs or family, on account of compliance or any attempts to comply with this authorization waive any right that may have to inspect any information provided abost me by any person or organization identified by me in this application Should my application be accepted. agree to be bound by the Bylaws and policies of the Charch of God and to refrain from any unscriptural conduct in the performance of my services on behalf of the church.

Signature

Your respective team leader may choose to have a orientation following the 2pm camp wide meeting on Monday. The Monday meetings ARE MANDATORY unless communicated prior to with the Youth Director.

I further state that HAVE CAREFULLY READ THIS APPLICATION, EVERYTHING IS TRUE TO THE BEST OF MY KNOWLEDGE, AND I AGREE TO ALL PARTS LISTED, READ, FILLED OUT, MARKED, AND SIGNED

I will be present and on time for Worker's Orientation on Monday afternoon at 2pm, the day camp begins. I understand that campers are not to arrive before check-in at 3pm. Therefore, I will make every effort to secure another person(s) to bring our campers, so that I can give my full attention to Orientation. In the event that my campers have no other means of transportation to Camp on Monday, I will guarantee transportation; I guarantee adult chaperone(s) to be responsible for their direct supervision until they are released to their cabin leader on Monday after registration. ** I will also be responsible for providing all meals at my cost for any camper upon arrival at camp until dinner on Monday.*

YesNo

AND SIGN THIS RELEASE AS MY OWN FREE ACT. This is a legally binding agreement which have read and understand.

Applicant's Signature

I Understand that NCR Youth Camp activities will be videoed as camp momentos and for promotional purposes. By signing this form, you agree to the use of any videos or photographs that may appear in for the above stated purposes.

Applicant's Signature .

Additional notes or information you want to share with us?

Please Note: Due to the nature of our camp structure, we will do our best to accommodate specific menus regarding food allergies.

FOREGOING RELEASE AND KNOW THE CONTENTS THEREIN,