Kids Camp Volunteer Application
Thank you for your interest in serving as a counselor for Kids Camp! Please fill out the information below.
First Name
*
Last Name
*
Phone Number
*
Email
*
Gender
*
Male
Female
Address Line 1
*
Address Line 2
City
*
State
*
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands (US)
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces (the) Americas
Armed Forces Europe
Armed Forces Pacific
Army Post Office (U.S. Army and U.S. Air Force)
Fleet Post Office (U.S. Navy and U.S. Marine Corps)
ZIP Code
*
Age
*
Birthdate
*
Home Church Name and City
*
Camper Age Preference
1st - 3rd Graders
4th - 6th Graders
No Preference
Is there a specific camper you would like to have in your group?
If you are the parent of a camper, would you like to have your child in your cabin? (your child must be the same gender as you)
Is there someone you would like to co-counsel with?
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Emergency Contact and Health Information
Please list the person who should be contacted in case you have an emergency.
First Name
*
Last Name
*
Emergency Contact Phone Number
*
Do you have any allergies?
Swimming Abilities:
I don't swim.
I am not a strong swimmer.
I am a decent swimmer.
I am a strong swimmer.
Background and Security
Do you have a recent background check on file at your local church? (If no, please contact your church to have a background check run.)
Yes
No
Can you perform the essential functions of the job for which you are applying, with or without reasonable accommodation?
Yes
No
CHILD ABUSE & CHILD NEGLECT: Have you ever been determined to be a perpetrator of child abuse or child neglect in any form?
Yes
No
HARASSMENT: The camp's policy is to prohibit all forms of harassment by our employees and volunteers. This includes sexual, racial, religious, and other forms of harassment. Have you ever been accused of harassment of any person including, but not limited to, workplace harassment?
Yes
No
CRIMINAL RECORD: Have you ever been convicted of a crime, other than a minor traffic offense?
Yes
No
Signature
Staff Member Signature
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Give a summary of your Christian faith, including your conversion and current spiritual growth.
*
Please describe your involvement in your local church.
*
What skills do you bring that will be an asset to CCD Camp?
*
Submit Registration
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