2023 Redemption Camp Counselor Application
General Info
Name
*
First Name
Last Name
Email Address
*
example@example.com
Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Age
*
Birth Date
*
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
T-Shirt Size
*
School and Church Info
High School (s) and Graduated Year
*
College(s) and expected graduation year
*
College major/minor
*
Campus minister or teacher reference name and phone number
*
1 specific way you have served or participated in expanding the Kingdom in either of these educational places
*
Church Name and Location
*
Membership Year
*
Pastoral Reference Name and Phone Number
*
Areas of Service/Teams You Serve On
*
1 specific way you have served or participated in expanding the Kingdom with church body
*
More Info About You
High school honors/awards/extra-curricular activities/sports
*
Work experience and special skills
*
Interests or hobbies
*
What do you hope to learn through this position on our staff?
*
In what areas in your life do you want to see the most improvement?
*
Areas of Interest
Select Areas of Interest
*
Lead Counselor
Food Service
Photographer
Videographer
Nurse
Activities Help
Audio/Visual Team
Worship Band (Please Select Area(s) of Interest)
Acoustic Guitar (Worship Band)
Electric Guitar (Worship Band)
Bass Guitar (Worship Band)
Drums/Cajon (Worship Band)
Keyboard/Piano/Synth (Worship Band)
Lead Vocals/Harmonizing (Worship Band)
Violin (Worship Band)
Other
Health Information
Emergency Contact Full Name/Relationship to you
*
Their Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Secondary Emergency Contact Full Name/Relationship to you
*
Their Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
List any allergies you have.
*
Current medications and reason for their use.
*
Do you suffer from any diseases/illnesses:
*
None
ADD/ADHD
Anxiety
Asthma
Aspergers
Autism
Back Injury/Problems
Depression
Diabetes
Digestive/Eating Disorder
Drug Addiction
Heart Problems
High Blood Pressure
Low Blood Pressure
Migraine
Seizure Disorder/Epilepsy
Respiratory Problems
Self Harm/Cutting
Orthopedic Problems
Other
If yes, what is your current course of treatment?
Any further information about your medical history?
Personal Testimony
Describe in detail your personal testimony
*
Have you been baptized?
*
Describe one way you have shared your faith to a non-believer?
*
Submit
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