Kids@Union Chapel Volunteer Application

ECY Youth Camp

VOLUNTEER APPLICATION
Which Youth Camp are you wishing to apply to volunteer for?

Nipgen Junior Youth CampNipgen Junior High CampNipgen Teens in ActionTeens of PraiseKidz CampSpring RetreatFall Retreat
Personal Information
Legal Name*

First NameMiddle NameLast Name
Home Address*
Date of Birth*

MonthDayYear
Date
Age*
Phone Number*
Best Time to Call*
E-Mail
Driver's License or State ID Number
If under 18, answer not required.
Social Security #
If under 18, answer not required.
Criminal/Social History

Have you at any time ever:*

	Yes	No
Been Arrested for any reason?
Been convicted of, or pleaded no contest to, any crime?
Engaged in, or been accused of, any act of child molestation, exploitation, or abuse?
Had your driver's license suspended or revoked?

Are you aware of:*

	Yes	No
Having traits or tendencies that could pose any threat to children, youth, or others?
Any reason why you should not work with children, youth, or others?

If the answer to any of these questions is "yes", please explain in detail below:
Church Information
What church or churches have you attended in the past five years?
Church #1*
Church #2
Do you hold membership with a Churches of Christ in Christian Union church?*

YesNoUnknown
Briefly Describe Your Relationship With Jesus Christ
Experience
Have you had other youth work experience?

YesNo
Organization*
Organization
Organization
References
Please provide three references. (Must be 18 years or older)
Reference #1*
Reference #2*
Reference #3*
Applicant Verification and Release
I recognize that the organization to which this application is being submitted is relying on the accuracy of the information contained herein. Accordingly, I attest and affirm that all of the information that I have provided is absolutely true and correct to the best of my knowledge.

I authorize the organization to contact any person or entity listed in this application, 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 herein 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.
Signature*

Clear
Date*

MonthDayYear
Date
Should be Empty:

ECY Youth Camp