• 2018 Virginia Church of God

    Youth Camp

    Volunteer Application

  • Before you begin please read the camp information packet by clicking here.

    Requirements for youth camp volunteers:

    • Committed Christian
    • 16 years of age or older (cabin leaders must be 18 or older)
    • Regular attender of a Church of God congregation
    • Endorsement by local pastor
    • Agree to and pass a background screening
    • If under 18 years of age you must submit a written endorsement from a school teacher or employer
    • If 18 years of age or younger, you must be a camper during Extreme week

    Your application is subject to approval of the camp administrator and the Virginia Church of God Youth and Discipleship Board.

    Please make sure that CAPS LOCK is off.

    While no one is rejected to work or attend Church of God youth camp on the basis of race, color, or creed, the state director of Youth and Discipleship and camp officials reserve the right to accept or reject any application for volunteer work at camps after review of said application reveals that the services of the applicant would not be in the best interest and success of the camp. This application is given every consideration, but its receipt does not imply that the applicant has been accepted as a worker. Applicants are accepted on a trial basis and if, in the final judgment of the camp officials, it is found that the applicant/staff member is not adaptable to the assignment and cannot be reassigned, or that the information given has been misrepresented, the acceptance of this application can be terminated without other cause or reason. In addition, investigation will be made as to your character, general reputation, personal characteristics, and adaptability to the particular position assigned. All applicants are required to undergo training and orientation provided by the State Youth Director’s office and under the supervision of the State Youth Board. Applicants are not required to provide information which is prohibited by Federal, State, or Local law.

    Fields designated with a * are required.

    This application provides a function for the uploading of a copy of your health insurance card. If you would like to utilize this function simply scan the front and back of the card or take a picture of it. Save that file to your computer and then attach it to the application when requested. Acceptable file types are PDF, JPEG, PNG and GIF.

    After clicking the SUBMIT button at the bottom of the application wait for the confirmation message to appear. Print the confirmation screen for your records. You will also receive a confirmation email at the address you specify.

    • Volunteer Application  

    • APPLICANT INFORMATION

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    • AVAILABILITY

    • Specify which camp(s) you are available to work and also choose your top three choices for position that you would like to fill during the week.

      Extreme Camp (Ages 15-18) - July 2 - July 6
      Velocity Camp (Ages 12-14) - July 9 - July 13
      Adventure Camp (Ages 9-11) - July 16 - July 20
      Discovery Camp (Ages 6-8) - July 23 - July 26

      I understand that this a request and not a definite assignment. Assignments will be made by the camp leadership team according to the best interest and success of the camping program.

    • BACKGROUND AND EXPERIENCE

    • Other church name  
    • Other church end  

    • Spiritual Experiences

    • WB Splitter  
    • Sanctification Splitter  
    • HS Splitter  
    • Membership Splitter  
    •   Answer
      Have you ever been convicted of or pleaded guilty to sexual assault, sexual abuse or child abuse?
      Have you ever been convicted of or pleaded guilty to a felony?
      Have you ever been charged, arrested, convicted of, or pleaded guilty to any crime?
      Have you ever been accused, charged, or alleged to have committed any act of neglecting, abusing, or molesting a child or youth?
      Have you ever been accused, charged, or alleged to have committed a theft?
      Have you ever been charged with moving traffic violations?
      Has your driver’s license ever been revoked or suspended?
      Have you ever been a victim of abuse (verbal, physical, sexual)?
      Have you ever been involved in a homosexual relationship?
      Are you currently addicted to prescription drugs?
      Do you use tobacco in any form?
      Do you drink alcoholic beverages?
      Do you take illegal drugs?
      Do you have problems sleeping?
      Do you have recurring nightmares or sleep disturbances?
      Do you have a history of using pornographic material?

    • REFERENCES

    • The pastor of the local Church of God congregation that you identified above will be contacted as your primary reference. If you are under age 18 you must provide information from a secondary reference. The secondary reference must also provide a written endorsement which can be attached to this form or sent directly to the youth camp office at PO Box 7547, Roanoke, VA 24019.

    • Secondary Reference  
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    • Secondary reference end  

    • EMERGENCY CONTACT INFORMATION


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    • MEDICAL INFORMATION

    •   Name of Medication Date Started Reason for taking When is it given (Breakfast, Lunch, Dinner, Bedtime, Other) Amount or dose given How is it given
      Medication 1
      Medication 2
      Medication 3
      Medication 4
      Medication 5
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    • Parental Consent  

    • If volunteer is unter the age of 18 a parent or guardian must complete the following medical consent section.

    • In the event that my child requires medical attention, I hereby give consent for the camp officials to seek assistance.

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    • Parental Consent Stopper  

    • HIPAA STATEMENT

    • Federal and Statelaws and regulations mandate patient confidentiality. Releasing medical information without proper authority may result in liability for, among other things, violations of the Health Insurance Portability and Accountability Act (”HIPAA”) regulations relating to this statute, invasion of privacy, defamation (harming the reputation), libel, or slander. Violations of HIPAA, or defamation may result in criminal as well as civil action or monetary penalties. Charges for breaking these laws range from misdemeanors to felonies. Penalties for breach of patient confidentiality range from paying a fine to incarceration in a correctional facility.

      All employees, students, vendors, and/or volunteer shall be expected to observe the strict confidentiality concerning patients even after his/her relationship with Virginia Church of God Youth Camp ends.

      Breach of confidentiality is defined as unauthorized use, discussion or release of confidential information regarding patients either identity, and or their hospital records.This violation of personal conduct justifies immediate termination of employee/student/vendor/volunteer status without regard to the employee’s/student’s/vendor’s/volunteer’s length of service or prior record or conduct.

      By acknowledging below, I certify that I understand the importance of maintaining patient confidentiality and that I agree to abide by the privacy policies and procedures adoptedby Virginia Church of God Youth Camp.

    • APPLICANT'S STATEMENT AND RELEASE

    • The information contained in this application is correct to the best of my knowledge. I authorize any references or churches listed in this application to give any information (including opinions) that they have regarding my character and fitness for youth camp work. In consideration of the receipt and evaluation of this application by the Church of God, I hereby release to any individual, church, youth organization, charity, employer, reference, or any other person or organization including record custodians, both collectively and individually, from any and all liability for damages of whatever kind or nature which may at this time result to me, my heirs or family, on account of compliance or any attempts to comply with this authorization. I waive any right that I have to inspect information provided about me by any person or organization identified by me in this application.

      I hereby consent for the State Director’s office to seek from local law enforcement any information which pertains to any record of conviction contained in its files or in any criminal file maintained on me whether local, state, or national. I hereby release the local or state police department from any or all liability resulting from such disclosure.

      Should my application be accepted, I agree to be bound by the bylaws and policies of the Church of God and to refrain from any unscriptural conduct in the performance of my services on behalf of the church. I also agree to participate in the training and enhancement programs provided by the State Youth and Discipleship Director’s Office in preparation of my participation this summer.

      In the event of an accident or serious illness, I hereby give my consent for diagnosis or treatment to be rendered to me by qualified medical personnel, both on and off campus, should such action be necessary in the opinion of camp officials.

      I further state that I have carefully read the foregoing release and know the contents thereof and I sign this release as my own free act.

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