Clone of Jr Counselor Registration Form

Adult Counselor Registration Form

Complete all fields listed below accurately. For any field that does not apply, please use N/A.
Legal Name*

First NameMiddle NameLast Name
Gender*

MaleFemale
Birth Date

MonthDayYear
Phone Number*
Please enter a valid phone number.
Church Affiliation*
Email Address*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Select Camp Shirt Size (Based on Unisex T-shirt Sizes)*

SmallMediumLargeExtra-large2XL3XL4XL
Why are you interested in an Homeschool Outdoor School Junior Counselor position? *
My fun camp counselor name will be *
*Subject to approval

Medical Information
Medical Insurance Co. & Policy Number*
Primary Physician*
Physician Phone Number*
Please enter a valid phone number.
Physician Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please list any medical or mental health history, including any that require medications or special accommodations(i.e. Diabetic, Asthma, Seizures, Anxiety, ADHD, ASD). *
Medications (including vitamins or supplements) currently taking and dosages:*
Allergies:*
Please let us know if you have an anaphylactic reaction to any known substance
List any medical restrictions of physical activities *
Food Allergies- Please only select what applies. A member of leadership will reach out to go over listed allergies and how best to accommodate them. An alternative will be provided, but adherence is the responsibility of the attendee.*

GlutenDairyVegetarianPeanuts/Tree NutsNoneOther
If Other, List Below:*
Emergency Contact*

First NameLast Name
Emergency Contact Phone Number*
Please enter a valid phone number.
Relationship of Emergency Contact*
In case of an emergency, this will authorize the Homeschool Outdoor School staff to act in their best judgement to seek medical attention through appropriate means, including ambulance transport and emergency room treatment (including but not limited to, injections, anesthesia, or surgery) as deemed necessary by attending health care personnel (i.e. EMT, First Responder and/or Physician). I accept responsibility for expenses incurred for such treatments.*

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Education, Training, and Experience
Occupation*
Employer*
If student, What school are you attending?*
Education and/or Special Training*
Languages Spoken (Other than English)*
Special Skills, Interests, or Hobbies*
Have you had CPR Training? If yes, please list most recent date of certification*
Have you had First Aid Training? If yes, please list most recent date of certification*
Background In Youth Programs
Have you been a camp counselor before? If yes, where, and how long?*
Please list all applicable events
Any experience in other youth programs?*
Memberships in other organizations?*

Adult Counselor Expectations and Responsibilities

We strive to provide quality leadership for youth participating in this program. The opportunity to work with youth is a privileged position of trust that should be held only by those who are willing to demonstrate behaviors that fulfill this trust. The following behavior expectations are provided for volunteers working in the Faith Filled Adventure Camp - Homeschool Outdoor School
- We expect that you will help or be in charge of a cabin of 5-10 children of your same gender. Your overnight accommodation will be with children in a room or cabin.
- During the day, we expect each adult to chaperone or teach/ lead groups of children to keep them safe and in an attitude of learning. (Learning and recreation groups will be co-ed).
- We hold a Young Earth, 7 Literal Day Creation Model and all science subjects should be taught in this context. A few resources of information that we endorse to carry an orthodox biblical view of creation are www.answersingenesis.org , www.icr.org , and www.creation.com
- Treat others in a courteous, respectful manner demonstrating behaviors appropriate to a positive role model for youth
- Abide by policies and guidelines of Homeschool Outdoor School
- Do NOT bring firearms to Faith Filled Adventure Camp - Homeschool Outdoor School.
- Do not consume alcohol, or use tobacco, marijuana, or vaping equipment, or any illegal substances at Faith Filled Adventure Camp; nor allow Faith Filled Adventure Camp youth campers under your supervision to do the same. (Please report to leadership if a camper is in possession of any of these substances)
- Recognize that verbal, sexual, or physical abuse and/or neglect of youth is unacceptable either within or outside the Faith Filled Adventure Camp program. Report all instances of suspected abuse to leadership.
- Treat animals humanely and leave them in their natural habitat
- Operate vehicles, and other equipment in a safe and responsible manner, only with a valid operator’s license and the legally required insurance coverage.
Signature*

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How would you like to serve the camp? (Please select all that apply)*

Chaperone a color groupLead Recreational ActivityTeach a classBe on the music / worship teamAssist Kitchen StaffOther
For the options you selected above, please provide more information (i.e. class title, recreational activity, desired color group, etc.)*
Camp Administration will follow up with you to discuss specifics.
I would like to be assigned to the same cabin as my same gendered children

YesNo
Requested Child's Name

Adult Counselor Code of Conduct

We strive to provide quality leadership for youth participating in this program. The opportunity to work with youth is a privileged position of trust that should be held only by those who are willing to demonstrate behaviors that fulfill this trust. The following behavior expectations are provided for volunteers working in the Faith Filled Adventure Camp - Homeschool Outdoor School. During Faith Filled Adventure Camp you will be away from your family. You will be living and studying in a different home- the Faith Filled Adventure Camp site. In order for everyone to live in harmony and learn, we have written this code of conduct. We strive to provide a respectful and cooperative learning environment for everyone attending. It is important to have a safe and enjoyable week at camp!
- Ensure safety of the campers at all times. Always know where your campers are. Enforce the buddy rule. NEVER be alone with just one camper.
- Chaperones must shepherd all campers to and from activities. Maintain order during class. If a camper must leave during an activity, make sure they have a buddy and keep them accountable.
- Be on the lookout for public displays of affection or signs that two people are becoming interested in each other. Stop any conversations concerning boy/girl relationships or other sexually related topics.
- Respect individual convictions and encourage kids to do the same. Stop any conversations about questionable movies or other media that might offend the convictions of others. Including but not limited to politics, or socio- economic issues.This includes no pranking.
- There must be at least one adult counselor at each table for mealtimes. Don’t congregate. Observe how the campers eat and encourage them to eat balanced meals.
- Strategically situate yourself in classes and activities so there are counselors throughout the room. Encourage campers to pay attention and be respectful.
- Be sensitive to those with learning disabilities or social ailments and maintain their dignity.
- Encourage selflessness. Make this week fun for your campers. Don’t be a grumpy counselor.
- Attend all classes and activities on time and fully prepared with all of your campers in your care.
- Bring any health-related concern, no matter how small, to the attention of Patches, our camp nurse. Help kids with diet issues and/or medication to remember to eat correctly and to get their medications.
- Never leave campers unattended.
- Bring any problem that you can’t or don’t want to handle to a Staff member.
- Help (don’t do it for them) your campers earn the clean cabin award.
- Guide campers in choosing and performing a skit for campfire at least once in the week.
- Deliver your campers on time and prepared for classes and activities, including appropriately dressed for the activities.
- Enforce lights out and quiet times. Afternoon quiet times are to be quiet and inside cabins.
- Keep bedwetting confidential. Be the last one out of the cabin after breakfast and check bags. Fold over ones that are wet.
- Whether or not you sit as a cabin, you are primarily responsible for the behavior of your cabin campers.
Signature*

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Release and Waiver of Liability and Indemnity Agreement

Read Carefully Before Signing
In consideration of being permitted to participate in any way in Faith Filled Adventure Camp - Homeschool Outdoor School and/or being permitted to enter for any purpose any restricted area (herein defined as any area where in admittance to the general public is prohibited), the parent(s) and/or legal guardian(s) of the minor participant named below agree:
1. The parent(s) and / or legal guardian(s) will instruct the minor participant that prior to participating in Faith Filled Adventure Camp - Homeschool Outdoor School, he or she should inspect the facilities and equipment to be used, and if he or she believes anything is unsafe, the participant should immediately advise the staff of such condition and refuse to participate. I understand and agree that, if at any time, I feel anything to be UNSAFE, I will immediately take all precautions to avoid the unsafe area and REFUSE TO PARTICIPATE further.
2. I/We fully understand and acknowledge that:
  1. There are risks and dangers associated with participation in Faith Filled Adventures Camp - Homeschool Outdoor School events and activities which could result in bodily injury, partial and/or total disability, paralysis and death.
  2. The social and economic losses and/or damages, which could result from these risks and dangers described above could be severe.
  3. These risks and dangers could be caused by the action, inaction or negligence of the participant or the action, inaction or negligence of others, including, but not limited to, the Releases named below.
  4. There may be other risks not known to us or are not reasonably foreseeable at this time.
3. I/We accept and assume such risks and responsibility for the losses and/or damages following such injury, disability, paralysis or death, however caused in whole or in part by the negligence of the releases named below.
4. I/We HEREBY RELEASE, WAIVE, DISCHARGE AND COVENANT NOT TO SUE THE *** facility used by the participant, including its owners, managers, promoters, lessees of premises used to conduct the Faith Filled Adventures Camp - Homeschool Outdoor School event or program, premises and event inspectors, underwriters, consultants and others who give recommendations, directions, or instructions to engage in risk evaluation or loss control activities regarding *** facility or events held at such facility and each of them, their directors, officers, agents, employees, all for the purposes herein referred to as “Release”…FROM ALL LIABILITY TO THE UNDERSIGNED, my/our personal representatives, assigns, executors, heirs and next of kin FOR ANY AND ALL CLAIMS, DEMANDS, LOSSES AND DAMAGES AND ANY CLAIMS OR DEMANDS THEREFORE ON ACCOUNT OF ANY INJURY, INCLUDING BUT NOT LIMITED TO THE DEATH OF THE PARTICIPANT, OR DAMAGE TO PROPERTY, ARISING OUT OF BUT NOT LIMITED TO EVENT(S) CAUSED OR ALLEGED TO BE CAUSED IN WHOLE OR IN PART BY THE NEGLIGENCE OF THE RELEASEE OR OTHERWISE.
5. I/WE HEREBY acknowledge that THE ACTIVITIES OF THE EVENT(S) ARE VERY DANGEROUS and involve the risk of serious injury and/or death/or property damage. Each of THE UNDERSIGNED also expressly acknowledges that INJURIES RECEIVED MAY BE COMPOUNDED OR INCREASED BY NEGLIGENT RESCUE OPERATIONS OR PROCEDURES OF THE RELEASEES.
6. EACH OF THE UNDERSIGNED further expressly agrees that the foregoing release, waiver, and indemnity agreement is intended to be as broad and inclusive as is permitted by the law or the province or state in which the event is conducted and that if any portion is held invalid, it is agreed that the balance shall notwithstanding continue in full legal force and effect.
7. On behalf of the participant and individually, the undersigned partner(s) and/or legal guardian(s) for the minor participant executes this Waiver and Release. If, despite this release, the participant makes a claim against any of the releases, the parent(s) and/or legal guardian(s) will reimburse the releases for any money they have paid to the participant, or on his behalf, and hold them harmless.
I HAVE READ THIS RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND HAVE SIGNED IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT, ASSURANCE, OR GUARANTEE BEING MADE TO ME AND INTEND MY SIGNATURE TO BE COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY THE LAW.

*** Facility: CAMP TADMOR - 43943 McDowell Creek Dr, Lebanon, OR 97355
Counselor Signature *

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Adult Counselor Registration Form

Medical Information

Education, Training, and Experience

Background In Youth Programs

References

Background

Adult Counselor Expectations and Responsibilities

Adult Counselor Code of Conduct

Release and Waiver of Liability and Indemnity Agreement