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.Format: (000) 000-0000.

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.Format: (000) 000-0000.

Relationship to applicant

Emergency Contact 2

First NameLast Name

Emergency Contact Number

Please enter a valid phone number.Format: (000) 000-0000.

Relationship to applicant

Do you have Medical Insurance?

Insurance Company

Policy Number

Medical Conditions camp staff need to be aware of

Allergies

Current Medications

Activity Restrictions

Do you have camp staff experience?

Do you have any experience in the following areas:

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

How long have you been saved?

Are you baptized in the Holy Spirit?

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?

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

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

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

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.Format: (000) 000-0000.

Reference 2

First NameLast Name

Email

example@example.com

Cell Phone

Please enter a valid phone number.Format: (000) 000-0000.

Reference 2

First NameLast Name

Email

example@example.com

Cell Phone

Please enter a valid phone number.Format: (000) 000-0000.

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