2026 Super Camp - Staff Application

  • Staff Application

    2026 Midlands Region Church of God Youth Camp

  • Teen Camp Dates: June 22nd through June 26th, 2026

    Kids Camp Dates: June 29th through July 2nd, 2026

    Jericho Hills Camp And Retreat Center

    900 Jericho RD Lucas, IA 50151

     General Requirements for Youth Camp Staff 

    1. Must be 15 years of age for Kids Camp workers and 19 for Teen Camp workers.  Persons 14 and under need can not apply
    2. Must be a regular attendee of a local church.
    3. Must submit a completed application.
    4. Must have a confidential endorsement of your local pastor.

    Those who are 18+ and are new applicants will be requested to authorize for a background check. If you have previously worked camp and it has been more than 1 year since you've had a background check, you will be requested to authorize for one. 

    Applicants are not required to provide information which is prohibited by Federal, State or Local law. This application is given every consideration, but its receipt does not imply that the applicant has been accepted as a camp worker. Applicants are accepted on a “trial basis” and if in the judgment of the camp officials, it is found that the applicant/staff worker is not adaptable to the assignment and cannot be reassigned, or that information given has been misrepresented, the acceptance of this application can be terminated without other cause or reason.

    In addition, investigation will be made as to your character, general reputation, personal characteristics and adaptability to the particular position to be assigned. All applicants are required to undergo training and orientation provided by the Youth Director’s office and under the supervision of the Youth Board.

  • Format: (000) 000-0000.
  • Gender*
  • Have you lived at this address longer than 2 years?*
  • Birth Date*
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  • Marital Status*
  • Do you have any health problems or physical limitations?*

  • In case of an accident or a serious illness, you have my permission to secure proper medical treatment.  (If under 18, parental signature is required)

  • Which camps are you able to work? Check all that apply.*
  • Which position would you to work?*
  • If Staff, which area do you prefer? (Check all that apply)
  • Spiritual Status*
  • Will campers from your church be at your camp?*
  • If yes, should they be placed in your room?

  • Contact Information in Case of Emergency

    One Emergency Contact is Required
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.

  • Staff Acknowledgement

  • I pledge to abide by all worker guidelines in both action and attitude, and dedicate yourself to the success of camp.*
  • I understand that the Camp Insurance Policy provides secondary coverage, and I provide primary coverage. I accept financial responsibility for any medical costs beyond the limits of the camp policy.*
  • I will be present and on time for Worker's Orientation at 10:00 am the day camp begins.  I understand that campers are not to arrive before check-in at 1:00 pm.*

  • I have read and answered all the questions.  I understand the importance of each statement.

  • Statement of Reservation
    While no one is rejected to work or attend Church of God Youth Camp based on race, color, or creed, the Regional Director of Youth and Discipleship does reserve the right to accept or reject an application for volunteer work at Church of God Youth Camps after review of the said application reveals that the services of the applicant would or would not be in the best interest and success of the camp.

  • Applicant's Statement

    The information in this application is correct to the best of my knowledge. I authorize any 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 any 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 to me, my heirs, or family, on account of compliance or any attempts to comply, with this authorization. I waive any right that I may have to inspect any 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 that I HAVE CAREFULLY READ THE PRECEDING RELEASE AND KNOW THE CONTENTS THEREOF, AND I SIGN THIS RELEASE AS MY FREE ACT.  This is a legally binding agreement which I have read and understand.

  • Addendum to Youth Camp Staff Application

    The following questions are placed here at the advice of our legal counsel. All questions must be answered. All responses are kept in strict confidnence.
  • Have you ever been charged, arrested, convicted or plead guilty to any crime?*
  • Have you ever been accused, charged, or alleged to have committed any act of neglecting, abusing, or molesting a child or youth?*
  • Have you ever been involved in homosexual activity?*
  • Have you ever been accused, charged, or alleged to have committed a theft?*
  • Are you addicted to prescription drugs?*
  • Do you use tobacco in any form?*
  • Do you drink alcoholic beverages?*
  • Do you take illegal drugs?*
  • Do you have problems sleeping?*
  • Do you have recurring nightmares or sleep disturbances?*
  • Do you have history of use of pornographic materials?*
  • Have you ever been charged with moving traffic violations?*
  • Has your driver's license ever been revoked or suspended?*

  • Personal Consent and Permission Form
    By signing below, you are granting permission for this application to be released by the Regional Youth & Discipleship director to those he deems necessary in processing your application.  “I certify to the best of my knowledge and ability, the information provided in this Application Form is true, correct, and complete.  I authorize investigation of all statements contained in this application, including the conducting of a national criminal background check.  I release any and all parties from any and all liability for any damage that may result from furnishing such information to the Church of God.”

     

    Acknowledgement of risk related to Covid-19
    By entering onto any property owned or rented by the Midlands Region Church of God or participating in any Midlands Region Church of God programs or events, I, (on behalf of myself and my family members) acknowledge and agree with the following: The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization and is reported to be extremely contagious. The state of medical knowledge is, of course, ever-evolving, but the virus is believed to spread from person-to-person contact and/or by contact with contaminated surfaces and objects, and even in the air. People reportedly can be infected and show no symptoms and therefore spread the disease. The exact methods of spread and contraction are unknown, and there is no known cure for COVID-19. Evidence has shown that COVID-19 can cause serious and potentially life-threatening illness and even death. Midlands Region Church of God cannot prevent me or my family members from becoming exposed to, contracting, or spreading COVID-19 while on any property of Midlands Region Church of God or when participating in Midlands Region Church of God programs or events. Therefore, by entering a Midlands Region Church of God facility or participating in one of its programs, I acknowledge that I may be exposing myself and my family members to and/or increasing my/our risk of contracting or spreading COVID-19. I expressly assume that risk, on behalf of myself and my family. I (on behalf of myself and my family members), hereby forever release and waive my right to bring suit against Midlands Region Church of God or any of its affiliates, officers, directors, employees or other representatives related to any of the foregoing.

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