Chosen Valley Camp Volunteer Leaders Application Form
This form is for all leaders aged 17 years and older. If you are aged 13-16 yrs please use the Holiday Camp Junior Leaders Application. This form should be filled in by the person applying.
Which camp are you applying to be a leader for?
*
Please Select
January 2026 Camp
April 2026 Camp
July 2026 Camp
Sept/Oct 2026 Camp
Leader Personal Details
The form is individual, if there is than one person from the same household please use a separate form .
Name of applicant
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number
Email
*
example@example.com
Gender
*
Male
Female
Date of Birth
*
-
Day
-
Month
Year
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Are you 18 years or older
*
Yes
No
Address where applicant normally resides
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Have you served as a Camp Volunteer Leader in 2025?
Yes
No
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Parent/Caregiver Permission
All leaders aged 17 years are required to have parental permission to attend camp.
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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Emergency Contact
Name of emergency contact
*
First Name
Last Name
Emergency Contact Phone Number
*
Please enter a valid phone number
Relationship to Applicant
*
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Personal Information
Are you a Christian
*
Yes
No
Why do you want to be a camp leader?
What experience/training/skills do you have that might be useful as a leader?
What if any musical abilities do you have?
Do you have a current First Aid Certificate
*
Yes
No
First Aid Expiry Date
-
Day
-
Month
Year
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List any paid employment (including part-time work) that you have been involved in over the past 5 years.
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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
Please select if you have any of the following dietary restrictions?
Dairy Free
Gluten Free
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Leadership Suitability
Do you have any criminal convictions against you?
*
Yes
No
Have you had any dealing with the Police or other authorities that may affect your position as a leader ?
*
Yes
No
Have you ever been asked to stand down from any leadership role (particularly with children) due to any alleged misconduct or inappropriate behaviour?
*
Yes
No
Please provide further details
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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 last applied
I will email this directly to the office at bookings@chosenvalley.org.nz
I have uploaded this below (you must upload a file to select this option)
Written Reference #2
*
I have supplied this reference when I last applied
I will email this directly to the office at bookings@chosenvalley.org.nz
I have uploaded this below (you must upload a file to select this option)
Upload Reference
*
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Proof of Identity
For all applicants we require proof of identity with ONE form of identification. For privacy reasons we would prefer that this be emailed directly to our office at bookings@chosenvalley.org.n PLEASE PROVIDE COPIES OF 2 FORMS OF IDENTIFICATION, ONE FROM EACH OF THE FOLLOWING LISTS
Primary Identification1
*
I have supplied this reference when I last applied
I will email this directly to the office at bookings@chosenvalley.org.nz
I have uploaded this below (you must upload a file to select this option)
Primary Identification (Check the box for identification you will/have supplied)
*
New Zealand passport
Overseas passport
NZ Emergency Travel document
NZ Certificate of Identity
NZ Birth Certificate issued on or after 1 Jan 1998 with unique identification number
NZ citizen certificate
Upload copy of Primary Identification
*
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Secondary Identification
*
I have supplied this reference when I last applied
I will email this directly to the office at bookings@chosenvalley.org.nz
I have uploaded this below (you must upload a file to select this option)
Secondary Identification (Check the box for identification you will supply) Photographic identification (marked by *) is preferred
*
NZ drivers licence*
NZ student photo identification card*
NZ employee photo identification card*
Upload copy of Secondary Identification
*
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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
*
Yes
No
Unsure
Police Vet Request & Consent Form
*
Please email me Police Vet documents to be completed and returned to Chosen Valley Camp
I have completed the form and uploaded it below
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Declaration
I understand the information I have provided via this application will be confidential and used for the purpose of establishing suitability for leadership. I undertand that this application does not automatically guarantee acceptance.
Applicant Signature
*
Date
*
-
Month
-
Day
Year
Date
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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