Staff Registration Form 2023

Staff Registration

Please read all information and fill out the form to the best of your ability.
Information:

Thank you for your interest in being a member of our staff for the 2023 NC West Youth Camp.

If you have any questions about being a camp staff member please email Josh Baker pastorjbake@gmail.com.

Requirements:
- Must have been out of high school for at least 3 years.
Training:

A required training will happen but will be annouced at a later time. This event will be held at the camp. If you cannot be there you must let Josh Baker pastorjbake@gmail.com know a week before the date of the training

Pricing:
- $200 per week at camp. Deposit due after approval.
All payments should come as one check per church unless you are the only person from your church.

Checks should be made out to: NC West Youth

Checks should be sent to:

Jordan Wright

PO Box 579

15303 US Highway 158

Summerfield, NC 27358

Location of Camp:

Victory Mountain Wesleyan Camp

3592 Youth Camp Rd, Sophia, NC 27350

Staff Personal Information
Select the camp(s) that you would like to serve as a Staff:*

High School June 25-30Middle School July 9-14
Staff Name*

First NameMiddle NameLast Name
Gender*

MaleFemale
Birth Date*

MonthDayYear
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Mobile Number*

Area CodePhone Number
E-mail*

Reference Information

If you are a youth pastor, the main youth leader at your church, or the spouse of; please leave the bottom two blank.
Church Attending With*
Are you the main youth leader or spouse of the youth leader at your church?*

YesNo
Church or youth pastors name:

First NameLast Name
Church or youth pastor email*
This is who we will send the references to. Please be informed that we get their reference back to approve you.

Staff Questionnaire

Please answer all of the questions to the best of your ability.
1. Do you currently serve in your church? If so in what capacity to you serve?*
2. Why do you want to be a Staff Member at camp?*
3. What has your relationship with Christ been like this year?*
4. Do you have any skills or certifications that we should know about? (CPR, Lifeguard, Musical, Etc.)*
5. Why should you be a staff member this year?*
6. Is there any reason you shouldn't be allowed to be a staff member?*
7. How many years have you served on our camp staff?*
8. We will have to do a background check for you when you are accepted. Do you have any problems with that?*

YesNo
9. Will you be able to stay during the entire camp?*

YesNo

Emergency Contact
Emergency Contact #1*

First NameLast Name
Relationship *
Phone Number*

Area CodePhone Number
Emergency Contact #2

First NameLast Name
Relationship
Phone Number

Area CodePhone Number

Media Permission
Photographs, film, video, or other images may be taken of you during camp. I consent to the use of my image for displays, brochures, videos, and other promotional materials with no compensation.*

YesNo
Name*

First NameLast Name
Signature*

Please use touch screen or mouse to sign your name. Clear

Camp Rules
CAMP RULES
1.   No members of the opposite sex in the same cabin.
2.   No fighting
3.    Camp curfew will be abided
4.    No stealing
5.    All vehicles will be parked at all times unless they are being used for planned activities (Student keys will be checked in a registration and returned upon leaving
6.    No vehicles used for transportation around camp
7.    Students must be present at all scheduled services and events in the designated locations
8.    No PDA will be allowed
9.    Modesty is of great importance. Leadership reserves the right to ask you to change and you must comply.
10.No use of alcohol, tobacco, vapes, and illegal drugs.
11.Students will respect the property and facilities of Victory Mountain, along with the property of NC West Youth and that of other students. Students will be held responsible for any vandalism and destruction.
12.No weapons of any kind. (Pocket knives and lighters are included).
13.Although pranks are fun you cannot do anything to anyone’s stuff, or anything that is publicly humiliating.
14.Electronic devices such as MP3 players, iPods, and cell phones cannot be used during scheduled programming, and may be confiscated if the student if a student does not comply with the rules.

I agree (at my own expense) to pick up my student early from camp should a disciplinary problem arise. I also understand and agree that I am liable for any and all damages done to any property or belongings which are damaged as a result of my student's actions.
Please sign below*

Clear
Should be Empty:

Staff Registration

Staff Personal Information

Reference Information

Staff Questionnaire

Emergency Contact

Media Permission

Medical

Camp Rules