2026 Summer Internship Application

Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email*

example@example.com

Phone Number*

Please enter a valid phone number.

Birthday*

Date

Age*

Instagram

T-shirt Size*

School / College you Attend*

Grade / Year*

Church you Attend*

Senior Pastor's Name

Youth Pastor's Name

Social Security Number*

Emergency Contact 1*

First NameLast Name

Emergency Contact Number*

Please enter a valid phone number.

Relationship to applicant*

Emergency Contact 2

First NameLast Name

Emergency Contact Number

Please enter a valid phone number.

Relationship to applicant

Do you have Medical Insurance?*

YesNo

Insurance Company

Policy Number

Medical Conditions camp staff need to be aware of*

Allergies*

Current Medications*

Activity Restrictions*

Do you have camp staff experience?*

YesNo

Do you have any experience in the following areas:*

Please select which area you would be interested in serving in:*

Rec CrewMedia Crew

How long have you been saved? *

Are you baptized in the Holy Spirit?*

YesNo

Share your testimony of salvation*

Describe your current walk with God (Are you growing? Slipping? How is your devotional life?)*

Are you involved in your local church? Please explain*

Do you currently vape, use tobacco, alcohol or any illegal drugs?*

YesNo

Have you been invovled in homosexual activity within the last 5 years?*

YesNo

Have you been convicted of child abuse or a crime involving actual or atttemped sexual molestation of a minor?*

YesNo

Have you been convicted of a crime, excluding misdemeanors and traffic violation in the past 10 years?*

YesNo

If YES, to any of the last 4 questions, please explain.

Reference 1*

First NameLast Name

Email*

example@example.com

Cell Phone*

Please enter a valid phone number.

Reference 2*

First NameLast Name

Email*

example@example.com

Cell Phone*

Please enter a valid phone number.

Reference 2*

First NameLast Name

Email*

example@example.com

Cell Phone*

Please enter a valid phone number.

As the applicant, I affirm that the information on the above form is true to the best of my knowledge. I authorize the Indiana District Assemblies of God NextGen Department to have a criminal background check done by the agency of their choosing and understand that my acceptance is contingent upon the results. I also agree to have my Pastor and/or Youth Pastor contacted for a reference regarding my charater and suitability for this internship. I release all such references from any liability for furnishing such evaluations to you, provided they do so in good faith and without malice. I waive any right that I may have to inspect references provided on my behalf. I agree to conform to all camp regulations and dress code. I also understand that participants at Lake Placid are liable for damage caused intentionally or maliciouly. Damage caused by a participant will be billed directly to the participant. I understand that accepting this intership is a voluntary activity and I pledge myself to a summer of cooperative ministry with the camp directors and will maintain a personal discipline and a spirit that exemplifies Christ at all times. I understand that if I do not adhere to the rules and guidelines, I may be dismissed from the program and any financial agreement, including scholarships will be voided.

How did you hear about this internship?*

Signature*

Summer Internship Application

Personal Information

Emergency Information

Medical Information

Experience

Testimony

References

Agreement