Summer Program Volunteer Application Form

Summer Program Volunteer Application
Personal Information
Name*

First NameLast Name
E-mail*
Phone Number*

CountryArea CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Date of Birth*

MonthDayYear
Country of Birth*
Country of Citizenship*
Gender*

MaleFemale
Marital Status*

SingleMarriedDivorced
Photo

Upload a current photo of yourself
Parent / Guardian Information
Name*

First NameLast Name
Phone Number*

Country CodeArea CodePhone Number
Email
example@example.com
Profile
Current Occupation
Name of School
Leave blank if you are not currently in school.
Highschool Graduation
Year
College Education Completed

Associate - 2yrBachelors DegreeMasters Degree
Please Indicate what position you're applying for:*

Summer Program VolunteerSummer Hospitality Intern
Please note that summer program volunteers will need to be available to arrive two weeks prior to the first full week in June and stay through the week following our last retreat in August.

The summer season in 2023 will run from May 21st through August 19th for Summer Program Interns.
Availability*
Please indicate the dates for which are able to serve
Skillsets, Abilities or Related Experience
i.e. outdoor skills, worship leading, maintenence, media, houskeeping, cooking or areas of leadership
Will You Bring Your Own Vehicle?

YesNo
Medical History

Please indicate any of the following you have experienced:
Allergies (food, drug, pollen, insect bites, etc.)*

YesNo
Diabetes or hypoglycemia*

YesNo
Epilepsy*

YesNo
Heart problems*

YesNo
Have you had an emotional or mental breakdown at any time?*

YesNo
Have you had any professional psychological counseling?*

YesNo
Have you been in the past or are you currently suffering from anorexia or bulimia?*

YesNo
Have you been in the past or are you currently a user of alcohol, tobacco or recreational drugs?*

YesNo
Have you ever experienced (check all that apply):

Excessive Nose BleedsHigh Altitude SicknessAsthmaBroncitisHigh Blood PressureUlcers
Explain in detail any “YES” answers:
List any medical problems, illnesses or chronic conditions experienced in the last three years:
List any medications you are currently taking:
Age*
Height*
Weight*
Health Condition*
Current Health Physician:
Name*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Emergency Contact:
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Country CodeArea CodePhone Number
Relationship to Applicant*
Insurance Provider / Group Name*
Policy Number*
I certify that the above medical information is correct to the best of my knowledge.
Signature*

Clear