Holiday Camp Junior Leaders Application Form
This form is for camp leaders aged 13-16 years. We require that a parent or caregiver fill in this form. If you are 17 years or older please use the following link https://form.jotform.com/243506789854876.
Which camp are you applying to be a leader for?
Please Select
January 2026 Camp
April 2026/ Autumn Adventure
July 2026/ Music & Dance Camp
Sept/Oct 2026 Camp
Who is the person filling in this application?
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number
Email
*
example@example.com
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 (You must be 13-16 yrs)
*
-
Day
-
Month
Year
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Address where applicant normally resides
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please provide the best email for sending the applicant further details about camp
Applicant Email
Phone Number
Please enter a valid phone number
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Swimming / Health/ Dietary Information
Applicant
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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For the Applicant
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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Written References
For all applicants we require: TWO written character references. These can be a pastor, teacher, employer or close family friend who is aged 18 years or older but NOT an immediate family member. If you have served as a leader in 2025, you will likely have one reference on file and are now required to provide a second reference .
Written Reference #1
*
I have supplied this reference when I applied last time
I have uploaded this below
I will email this directly to the office at bookings@chosenvalley.org.nz
Written Reference #2
*
I have supplied this reference when I applied last time
I have uploaded this below
I will email this directly to the office at bookings@chosenvalley.org.nz
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Proof of Identity
For all applicants we'd prefer two forms of identification but a minimum of ONE form of identification is acceptable.
Primary Identification
*
I have supplied this identification when I applied last time
I will email this directly to the office at bookings@chosenvalley.org.nz
I have uploaded this below
Primary Identification (please check the box for identification you are/have supplied)
*
New Zealand passport
Other passport
NZ Emergency Travel document
NZ Birth Certificate issued on or after 1 Jan 1998 with unique identification number
NZ student photo identification card
Other
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Secondary Identification
*
I have supplied this identification when I applied last time
I will email this directly to the office at bookings@chosenvalley.org.nz
I have uploaded this below
I don't have another form of identification
Secondary Identification (please check the box for identification you are supplying)
*
New Zealand passport
Other passport
NZ Emergency Travel document
NZ Birth Certificate issued on or after 1 Jan 1998 with unique identification number
NZ student photo identification card
I don't have another form of identification
Secondary Identification Upload
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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. I understand that the information provided in this application is confidential and will be used for the purpose of establishing suitability for Junior Leadership. I understand that this application does not automatically guarantee acceptance
*
Yes
Parent / Guardian Signature
*
Date Signed
*
-
Day
-
Month
Year
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Billing Details
The cost for Trainee & Junior Leaders is $160.00/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.
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