This registration is for Mauldin Youth Camp Workers. It is at the campground located in Simpsonville, SC. Is this the camp you want to attend?
Yes
No
Pee Dee Youth Camp Worker
If you would like to register to be a Pee Dee Youth Camp worker don't click next. Copy this link https://form.jotform.com/223466318705155 and paste it in your search bar to go to the Pee Dee Youth Camp located in Simpsonville, SC.
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Mauldin Youth Camp Staff Application
Full Legal Name
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First Name
Middle Name
Last Name
Preferred Name
First Name
Last Name
Gender
*
Male
Female
T-Shirt Size
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Please Select
Small
Medium
Large
X-Large
2Xl
3XL
4XL
5XL
Email
*
example@example.com
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Have you lived at this address longer than 2 yrs?
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Yes
No
If your answer was no, please list your previous address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Birthdate
*
-
Month
-
Day
Year
Date
Age
Date
-
Month
-
Day
Year
Date
Days
Present Occupation
Employer
Driver's License #
State
Social Security Number
*
Needed for Background Check
Do you have any health problems or physical limitations?
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Yes
No
If yes, please explain:
List any allergies or medications you may be taking:
In case of an accident or a serious illness, you have my permission to secure the proper medical treatment. (If under 18, parental signature is required)
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Clear
Which camps are you able to work? Please check all that apply.
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Mauldin Senior (June 26-June 30)
Mauldin Junior (July 3-7)
Mauldin Intermediate (July 10-14)
Mauldin Mini (July 17-20)
What position would you like to work?
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Dorm Leader
Staff
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Will campers from your church be at your camp?
Yes
No
If yes, should they be placed in your room?
Yes
No
Does not matter
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Please remember that staff members are called upon to help wherever a need arises. Staff must be flexible and maintain a positive second mile. Check any areas you are wanting to work.
Cafeteria
Recreation
Certified Lifeguard
Nurse
Canteen
Special Activities
Other
Please check one
I will reside at camp and bunk in the staff quarters
I will work, but will provide my own quarters
I will help during the day, but must drive home each night
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Name of church you attend
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Pastor
*
Pastor's Email (Needed for Pastoral Recommendation)
*
example@example.com
Spiritual Status: Check appropriate spaces
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Saved
Sanctified
Holy Ghost Baptism
Baptized in Water
Church Member
Local Church Experience - List all positions and church work you have been involved in:
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List the names of other churches you have attended regularly during past five years:
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By initialing here you pledge to abide by all worker guidelines in both action and attitude, and dedicate yourself to the success of camp.
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Yes
No
By initialing here you understand that the Camp Insurance Policy provides secondary coverage, and I provide primary coverage. I accept financial responsibility for medical costs beyond limits of camp policy state here: Medical & Hospital $2500, Dental $300.
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Yes
No
I will be present and on time for Worker's Orientation at 9:00 am the day camp begins. I understand that campers are not to arrive before check-in at 1:00 pm. Therefore, I promise that another person will bring our campers so that I can give
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Yes
No
I have read and answered all the questions. I understand the importance of each statement. I give you my word.
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Clear
Statement of Reservation
While no one is rejected to work or attend Church of God Youth Camp on the basis of race, color, or creed, the State Director of Youth and Discipleship does reserve the right to accept or reject an application for volunteer work at Church of God Youth Camps after review of said application reveals that the services of the applicant would or would not be in the best interest and success of the camp.
Applicant's Statement
The information contained in this application is correct to the best of my knowledge. I authorize any references listed in this application to give you any information (including opinions) that they may have regarding my character or fitness for children or youth work. In consideration of the receipt and evaluation of this application by the Church of God, I hereby release any individual, church, youth organization, charity, employer, reference, or any other person or organization, including record custodians, both collectively and individually, from any and all liability for damage of whatever kind or nature which may at any time result to me, my heirs, or family, on account of compliance or any attempts to comply, with this authorization. I waive any right that I may have to inspect any information provided about me by any person or organization identified by me in this application. Should my application be accepted, I agree to be bound by the Bylaws and policies of the Church of God, and to refrain from unscriptural conduct in the performance of my services on behalf of the church.
I further state that I HAVE CAREFULLY READ THE FOREGOING RELEASE AND KNOW THE CONTENTS THEREOF AND I SIGN THIS RELEASE AS MY OWN FREE ACT. This is a legally binding agreement which I have read and understand.
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Clear
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Addendum to Youth Camp Staff Application
The following questions are placed here at the advice of our legal counsel. All questions must be answered. All responses are kept in strict confidnence.
Have you ever been charged, arrested, convicted or plead guilty to any crime?
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Yes
No
Would you be willing to discuss this matter with a pastor or ministry leader?
Yes
No
Have you ever been accused, charged, or alleged to have committed any act of neglecting, abusing, or molesting a child or youth?
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Yes
No
Would you be willing to discuss this matter with a pastor or ministry leader?
Yes
No
Have you ever been involved in homosexual activity?
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Yes
No
Would you be willing to discuss this matter with a pastor or ministry leader?
Yes
No
Have you ever been accused, charged, or alleged to have committed a theft?
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Yes
No
Are you addicted to prescription drugs?
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Yes
No
Do you use tobacco in any form?
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Yes
No
Would you be willing to discuss this matter with a pastor or ministry leader?
Yes
No
Do you drink alcoholic beverages?
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Yes
No
Would you be willing to discuss this matter with a pastor or ministry leader?
Yes
No
Do you take illegal drugs?
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Yes
No
Do you have problems sleeping?
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Yes
No
Do you have recurring nightmares or sleep disturbances?
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Yes
No
Do you have history of use of pornographic materials?
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Yes
No
Have you ever been charged with moving traffic violations?
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Yes
No
Has your driver's license ever been revoked or suspended?
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Yes
No
Personal Consent and Permission Form
By signing below, you are granting permission for this application to be released by the state Youth & Discipleship director to those he deems necessary in processing your application. “I certify to the best of my knowledge and ability, the information provided in this Application Form is true, correct, and complete. I authorize investigation of all statements contained in this application, including the conducting of a national criminal background check. I release any and all parties from any and all liability for any damage that may result from furnishing such information to the Church of God.”
Signature
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Clear
Acknowledgement of risk related to Covid-19
By entering onto any property of South Carolina Church of God or participating in any South Carolina Church of God programs or events, I, (on behalf of myself and my family members) acknowledge and agree with the following: The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization and is reported to be extremely contagious. The state of medical knowledge is, of course, ever-evolving, but the virus is believed to spread from person-to-person contact and/or by contact with contaminated surfaces and objects, and even in the air. People reportedly can be infected and show no symptoms and therefore spread the disease. The exact methods of spread and contraction are unknown, and there is no known cure for COVID-19. Evidence has shown that COVID-19 can cause serious and potentially life-threatening illness and even death. South Carolina Church of God cannot prevent me or my family members from becoming exposed to, contracting, or spreading COVID-19 while on any property of South Carolina Church of God or when participating in South Carolina Church of God programs or events. Therefore, by entering a South Carolina Church of God facility or participating in one of its programs, I acknowledge that I may be exposing myself and my family members to and/or increasing my/our risk of contracting or spreading COVID-19. I expressly assume that risk, on behalf of myself and my family. I (on behalf of myself and my family members), hereby forever release and waive my right to bring suit against South Carolina Church of God or any of its affiliates, officers, directors, employees or other representatives related to any of the foregoing.
Signature
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Clear
Submit
Should be Empty: