Holiday Camp Leaders Application Form
These forms are required to be a leader at holiday camp.
Who is the person filling in this application?
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number
What camp are you applying to be a leader for?
Please Select
July - Celebration Camp
Sept/Oct - Above & Beyond Camp
January 2025 Camp
Are you the person applying to be a camp leader?
*
Yes
No
What is your relationship to the applicant
*
Parent
Caregiver
Social Worker
Other
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Leader Information
The form is individual, if you have more than one person from the same household please use a separate form .
Name of applicant
*
First Name
Last Name
Gender
*
Male
Female
Date of Birth
*
-
Day
-
Month
Year
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Address where applicant normally resides
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number
Email
*
example@example.com
What level of leadership position are you applying for?
*
Trainee leader - first year in leadership role
Junior Leader - aged 13-15yrs and previously served as a Trainee
Senior leader - aged 16-18yrs
Adult Supervisor
Unsure
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Swimming / Health/ Dietary Information
Campers
Applicant Swimming Ability
*
Non-Swimmer
Swimmer
Confident Swimmer
Doe you have any allergies or health conditions that we should be aware of?
*
Yes
No
Please explain
Do you have any food allergies?
*
Yes
No
Please explain
Please select if you have any of the following dietary restrictions?
Dairy Free
Gluten Free
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Emergency Contact
Name of Medical Centre
*
Where the applicant is enrolled
Phone Number
*
Number for Medical Centre
Name of emergency contact
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number
Relationship to leader
*
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Is the applicant 16 years or older?
*
Yes
No
Are you a Christian
*
Yes
No
Why do you want to be a leader?
What experience/training/skills do you have that might be useful as a leader?
Do you have any musical abilities.
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Parent/Caregiver Permission
Name of Parent/Caregiver
*
First Name
Last Name
Relationship to Applicant
*
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number
Permission: Parent/caregiver gives permission for their child to attend camp as a leader
*
Yes
Parent / Guardian Signature
*
Date Signed
*
-
Day
-
Month
Year
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Police Vetting
If you are 17 years or older, it is a requirement that all volunteer leaders be police vetted every 3 years. This process can take some time so we suggest that applicants who are 16 years begin this process. The "Request & Consent" form can be downloaded at https://www.police.govt.nz/about-us/publication/police-vetting-forms and also requires two forms of identification be provided.
Applicant has a current Police Vet with Chosen Valley Camp
*
Under 16 years - not required
Yes
No
Unsure
Police Vet Request & Consent Form
*
Please email me Police Vet documents to be completed and returned to Chosen Valley
I have completed the form and uploaded it below
Browse Files
Drag and drop files here
Choose a file
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of
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Billing Details
The cost for Trainee Leaders is $150.00/child. Fees can be paid by instalments prior, please email bookings@chosenvalley.org.nz to arrange this. Otherwise please pay upon receipt of your invoice. Full payment is required before camp begins. Please note that we have no Credit Card or EFTPOS facilities
Payment Options:
*
I will pay via bank deposit - an invoice will be emailed to you
I qualify for a subsidy
Billing Name
*
Name of the person or organization paying
Billing Email Address
*
Email of the person receiving the invoice
Does the invoice require a purchase order
*
Yes
No
Purchase Order Number
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Once you have submitted your application, we will assess your suitability and be in contact within 7 days with further information.
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