GARDENDALE ROYAL FAMILY KIDS' CAMP 2016 - RETURNING COUNSELOR/STAFF APPLICATION
PERSONAL INFORMATION
DATE:
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Month
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Day
Year
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FULL NAME:
First Name
Last Name
GENDER:
DATE OF BIRTH:
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Month
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Day
Year
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AGE:
PERSONAL ADDRESS:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
MARITAL STATUS:
OCCUPATION:
NUMBER OF YEARS IN OCCUPATION:
PRIMARY PERSONAL PHONE NUMBER:
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Area Code
Phone Number
WORK PHONE NUMBER:
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Area Code
Phone Number
PERSONAL E-MAIL ADDRESS CHECKED REGULARLY:
EMERGENCY CONTACT:
EMERGENCY CONTACT'S PHONE NUMBER:
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Area Code
Phone Number
T-SHIRT SIZE:
Please Select
Adult Small
Adult Medium
Adult Large
Adult Extra Large
Adult Extra Extra Large
Check any of these for which you are certified:
CPR
FIRST AID
LIFE GUARD
NURSE
EMT
Other
Have you worked with or associated with abused, neglected, or abandoned children this past year?
Yes
No
If you answered "yes," in what way?
Please describe why you wish to return as a counselor or staff member for abused and neglected kids.
MEDICAL HISTORY
Have you had any medical problems?
Yes
No
If you answered "yes," please describe:
Do you take any medications?
Yes
No
If you are taking medications, please list them and any side effects.
Have you had any serious injuries or illnesses since the last camp?
Yes
No
If you answered "yes," please explain.
PERSONAL GROWTH
If you were abused, neglected or abandoned as a child, how did that affect you at camp?
Please describe your spiritual growth since you have been a Royal Family Kids’ Camp staff member or counselor:
How has Royal Family Kids’ Camp made an impact on your life?
From your experience, what would you suggest to a new counselor or staff member coming for the first time?
Can you name a staff member or counselor that was a great help to you? And in what way?
How has your family responded to you being involved with Royal Family?
What current ministries or activities are you involved with at your church?
What new strengths have you discovered since working with abused kids?
What new weaknesses have you discovered since working with abused kids?
For returning counselors: This year I would prefer my campers to be:
6-7 years old
8-9 years old
10-11 years old
No preference
List any suggestions you feel would make the camping experience for the kids, counselors & staff even better!
Since your original application, have you been arrested for a criminal offense?
Yes
No
Since your original application have you been accused of any sexual misconduct?
Yes
No
Since your original application have you been convicted of any sexual misconduct?
Yes
No
Since your original application have you taken drugs other than prescription drugs?
Yes
No
If you answered “YES” to any of the above please explain.
By typing my name, I hereby signify the above information is true and correct to the best of my knowledge.
Date of Signature:
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Day
Year
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