2023 NM District Kids Camp Counselor Application

Campfire Stories

July 12-14, 2022
Bonita Park Campground
Ruidoso, New Mexico

Application Deadline - June 15th
Application Fee $130.00 (Non-refundable) $150 after June 15th

NOTE: All Items Marked with * are REQUIRED

ALL Counselors - Before applying to serve as a Camp Counselor, you must have completed the NM District "Children and Youth Worker Application."

JUNIOR Counselors - You will be required to have a parent or guardian sign this application, so be sure they are available before you fill it out.

This form is being filled out on a secure site

YesNo

YesNo / Unknown

YesNo

Adult Counselor (Must be 18+)Junior Counselor (Ages 14-17)

MaleFemale

Full Name*

First NameMiddle NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone*

Area CodePhone Number

E-mail*

Church Name, Address & Pastor's Name*

T-Shirt Size - Choose One

In Case of Emergency Contact*

First NameLast Name

Emergency Contact Number*

Area CodePhone Number

NM District Group @ BONITA PARK CAMP
INDEMNIFICATION AND RELEASE OF LIABILITY AGREEMENT

NOTE: You (or a parent/guardian, if a minor) must download, sign and return to Bonita Park the INDEMNIFICATION AND RELEASE OF LIABILITY form. It will be emailed to you after you complete the registration and is also available to download at our website. You can also download it by clicking here.

Verification and Release

I recognize that the NM District Church of the Nazarene is relying on the accuracy of the information I provide on the Children’s / Youth Work Application Form. Accordingly, I attest and affirm that the information I have provided is absolutely true and correct.

I authorize the organization to contact any person or entity listed on the Children’s / Youth Work Application Form, and I further authorize any such person or entity to provide the organization with information, opinions, and impressions relating to my background or qualifications.

I voluntarily release the organization and any such person or entity listed on the Children’s / Youth Work Application Form from liability involving the communication of information relating to my background or qualifications. I further authorize the organization to conduct a criminal background investigation if such a check is deemed necessary.

I have carefully read the policy and procedures of the organization, and I agree to abide by them and to protect the health and safety of the children or youth assigned to my care or supervision at all times.

YesNo

We are sorry, but unless you verify that you have read and consented to the above terms and conditions, we can not accept your application.

Sign below using your computer mouse or (if using a touch screen) your finger/stylus.

NOTE: You are ONLY agreeing to the above "Terms and Conditions." You (or a parent/guardian, if a minor) must still download, sign and return to Bonita Park the INDEMNIFICATION AND RELEASE OF LIABILITY form.

Parent/Guardian Signature*

Applicant Signature*

Pay Online by TithelyMail Check Drawn on Church Account

Please make your check (drawn on Church Business Account) payable to:
NM District Church of the Nazarene

Memo line:
Kids Camp Counselor

Mail to:
Christa Storch
1211 Carrizo St
Los Lunas, NM 87031

Use your phone to scan the following QR-Code and go to the Tithely Web Page. A $5 charge is added to the camp fee for using Tithely. The fee will be $135 by June 15th or $155 after June 15th.

NM District Kids Camp Counselor Application 2023