2024 Delmarva-DC Youth Camp Worker Application

Delmarva-DC Summer Retreat/YC Staff Application
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email Address:*
example@example.com
Male or Female (check appropriate)*

FemaleMale
Birthday*

MonthDayYear
Date
Age*

Please choose the camp(s) you would like to work:*

Teen Retreat: June 22-25Junior Retreat: June 26-29
Teen Retreat Cabin Leaders MUST be 21 or older &

Junior Retreat Cabin Leaders MUST be 18 or older
Please choose the position you are applying for:*

Cabin Leader (Teen)Cabin Leader (Junior)Recreation StaffCanteenStaff (YB Only)Other
Physical Information:
Do you have any health problems or physical limitations?*
If you answered YES to the above question, please explain, If no put N/A.*
List any allergies you have:*
List medication you are currently taking:*

Spiritual Status
Please check where applicable:*

SavedSanctifiedHoly Spirit BaptizedBaptized in water
Name of your local church:*
Your Lead Pastors Name:*
Your Lead Pastors Cell Phone Number*
Please enter a valid phone number.
Your Lead Pastors Email*
example@example.com

1. Have you ever been convicted of or plead guilty to sexual assault, sexual abuse, or child abuse?*
2. Have you ever been convicted of or plead guilty to a felony?*
3. Have you ever been charged, arrested, convicted of or plead guilty to any crime?*
4. Have you ever been accused, charged, or alleged to have committed any act of neglecting, abusing, or molesting a child or youth?*
5. Are you currently engaged in sexual immorality (i.e.: heterosexual or homosexual relations?)*
6. Have you ever been accused of, charged or alleged to have committed a theft?*
7. Are you addicted to any prescription drugs?*
8. Do you use tobacco in any form?*
9. Do you drink alcoholic beverages?*
10. Do you take illegal drugs?*
If you answered YES to Questions 1 - 10, would you be willing to discuss this matter with a pastor or ministry leader?*
Phone or Facetime interviews may be done as needed to determine the best outcome for camp planning.
BACKGROUND CHECK PROCESS:
Our insurance company says we MUST do this. We are in need of further information from each of you. Please go to the following website, log on and complete the forms. You will not be accepted without this!

Online Background check link: https://ministryopportunities.org/DelmarvaDCOGYD

If you have any questions, please feel free to contact 410-531-5351. This should be done ASAP.
APPLICANTS STATEMENT

The information contained in this application is correct to the best of my knowledge. I authorize the references listed in this application to give you any information (including opinions) that they may have regarding my character or fitness for children or youth work. In consideration of the receipt and evaluation of this application by the Church of God, I hereby release said individual, church, youth organization, charity, employer, reference, or any other person or organization, including record custodians, both collectively and individually, from any and all liability for damage of whatever kind or nature which may at any time result in me, my heirs, or family, on account of compliance or any attempt to comply, with this authorization. I waive any rights that I may have to inspect the information provided about me by any person or organization identified by me in this application.
Should my application be accepted, I agree to be bound by the Bylaws and policies of the Church of God, and to refrain from unscriptural conduct in the performance of my services on behalf of the church.
I further state the I HAVE CAREFULLY READ THE FOREGOING RELEASE AND KNOW THE CONTENTS THEREOF AND I SIGN THIS RELEASE AS MY OWN FREE ACT. This is a legally binding agreement which I have read and understand.
Applicants Signature:

Clear
Todays Date:

MonthDayYear
Date
STATEMENT OF RESERVATION
While no one is rejected to work or attend Church of God Youth Camp on the basis of race, color, or creed, the Regional Director of Youth & Discipleship does reserve the right to accept or reject any application for volunteers to work at Church of God Youth Camp after review of said application reveals that the services of the applicant would or would not be in the best interest and success of the camp.
Should be Empty:

Delmarva-DC Summer Retreat/YC Staff Application

Physical Information:

Spiritual Status