LSBC Ref Form

Lake Springfield Baptist Camp

5878 Iron Bridge Road Chatham, IL 62629

Phone: 217-441-1813

Email: Office@lsbconline.com

PERSONAL REFERENCE FORM
Reference Questionnaire

The applicant has submitted an application to, and is under consideration by, the Staff of Lake Springfield Baptist Camp for the 2024 Summer Camp season as a Camp Counselor. We would greatly appreciate your input regarding the following personal reference questions. Your reply will be held in confidence. Thank you for your immediate response.
Your Name*

First NameLast Name
Personal Reference
Applicant's Name*
How long have you known the applicant?*
In what capacity do you view your relationship with applicant (check one)?*

AcquaintanceCasual FriendClose FriendTeacher/Pastor/CounselorOther
How would you describe the applicant's spiritual maturity? (check one) Not Very 1 - Extremely 5*

12345Don't Know
Please check all the words below which you believe accurately describe the applicant*

TimidModestLovingIntelligentPatientDeliberateConsiderateSelfishMotivatedSocially AwkwardGentleImpulsiveTactfulMatureStudiousCongenialRelaxedSecureAbrasiveCompassionateImpatientNervousAngrySarcasticVerbalStubbornKindOrganizedTrustworthyOther
Does the applicant possess a teachable spirit and a willingness to accept instruction from those in leadership?*

YesNo
Have you observed the applicant working with children?*

YesNo
Do you believe this applicant will be successful working with children? Why or why not?*
Does the applicant have any physical, emotional, mental or spiritual struggles you are aware of that may interfere with their capacity to serve at camp?
We appreciate any additional comments that may assist us in making the best selections possible for camp.
Signature (sign with finger on mouse pad or with your mouse)*
Reference Name*
Phone Number*

Area CodePhone Number
Date*

MonthDayYear
Should be Empty:

Reference Questionnaire

Personal Reference