Manna Resort Counselor Application

Please list any alergies, medical conditions, or limitations pertinent to helping at camp: If you bring any medication to camp, it must be in its original container and turned in to the camp nurse. (Type NONE, if none)*
Medical Insurance Company*
Policy Number*
Doctor's Name*
Doctor Phone*

Please list your previous youth/child related work*
How many years have you helped at Manna?*
Have you ever been accused or convicted of any form of child abuse?*

YesNo
Have you ever been convicted of a crime?*

YesNo
Applicant Signature*

Clear
Parent Signature (If applicant is under 19 years of age)*

Clear
How and when did you become a Christian?*
How does your faith affect your daily life?*
How do you keep your relationship with Christ active and growing?*
What talents, abilities, or experiences do you have that you would be willing to share with us this summer?*
Do you have anything else you would like to share about yourself or any questions/concerns that you would like us know?*
Please list the names, relationship, (pastor, teacher, friend, etc.) and phone number of two references we may call.
Name*

First NameLast Name
Relationship to applicant*
Phone Number*
Please enter a valid phone number.
Name*

First NameLast Name
Relationship to applicant*
Phone Number*
Please enter a valid phone number.
Your Church Name and Location*
Phone Number*
Please enter a valid phone number.
May we contact your church to confirm this information?*

YesNo
Should be Empty: