2026 Summer Camp Volunteer Application

2026 Summer Camp
Volunteer Information
DirectorCabin CounselorCounselor-in-Training (Ages 15-17)Other
If you selected "Other" above, please describe what you would like to volunteer for.
Full Name*

First NameLast Name
Name preferred for nametag*
Pronouns*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Birthdate*

MonthDayYear
Date
Cell Phone *
Please enter a valid phone number.
Email*
example@example.com
Home Church (include city) - First Christian Church, Jacksonville*
Gender*
XSmallSmallMediumLargeXLargeXXLargeXXXLarge
Talents, Gifts, Ministries

Please check talents, gifts, ministries that you can contribute to this program.
MusicDanceWorship/DevotionsService ProjectStorytellingGroup LeaderArts/CraftsNature/Outdoor AcitivitesGamesOther
If you selected "Other" above, please provide details
Camp Preference

Using the numbers 1-6 (#1 being your first choice), prioritize which camp you prefer to serve.

Prioritize your camp request with choices from 1st - 6th (maximum) NOTE: Counselor-In-Training [CIT] choices are Junior Camp and Middle School (Chi Rho) camp.

Rows	1st Choice	2nd Choice	3rd Choice	4th Choice	5th Choice	6th Choice
Beyond High School Camp: HS grads of 2020-2025 (June 3-6): Minimum Age-26 years
High School (CYF) Camp: Grades 9-12 (June 7-13): Minimum Age-22 years
Junior Camp: Grades 3-5 (June 16-20): Minimum Age-18 years and CIT
Middle School (Chi Rho) Camp: Grades 6-8 (June 22-27): Minimum Age-19 years and CIT
High School Canoe Camp: Grades 9-12 (June 28-July 3): Minimum Age-22 years
Outdoor Adventure: Grades 7-10 (July 5-10): Minimum Age-19 years
Camp UNO (w/Adult): Grades 5-2 (July 10-12): Minimum Age-18 years
Family Camp: All ages (September 5-7): Minimum Age-22 years

Health Information
YESNO
If you answered NO above, please explain below.
Insurance Information

Please attach a copy of your insurance card (front and back). The campers insurance is primary and the limited Florida Disciples Regional Church insurance is secondary. The Florida Disciples Regional Church insurance supplements only those accidents and illnesses that occur during camp.
YESNO
Please upload a copy of your insurance card (front and back) in here.

Cancelof
YESNO
Physician's Name
Physician's Phone
Please enter a valid phone number.
Please list all allergies: Example - bee sting, mold, seasonal allergies, peanuts, ibuprofen, etc. N/A for None*
Please list any current medical conditions or concerns. N/A for None*
YESNO
Medications

If applicant will be taking regular medication at camp, complete the following in the space below: Name of MEDICATION; DOSAGE; TIME medication is taken; REASON - for what condition the medicine is being taken.
Medication - Dosage - Time - Reason
Emergency Contact Information
Primary Emergency Contact*

First NameLast Name
Relation to applicant*
Main Phone Number - Cell if applicable*
Please enter a valid phone number.
Secondary Phone Number
Please enter a valid phone number.
Alternate Emergency Contact Person(s)
1. Alternate Emergency Contact *

First NameLast Name
Relation to applicant*
Phone Number*
Please enter a valid phone number.
2. Alternate Emergency Contact

First NameLast Name
Relation to applicant
Phone Number
Please enter a valid phone number.
Additional Comments

Please provide any other information of which we should be aware.
Special Dietary Needs or Other Information. N/A if none.*
References

List two (2) names for references. One of them must be the minister or church officer of your home congregation. Note: References must fill out separate reference form (online) for application to be complete.
Minister/Church Officer
Minister/Church Officer Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Second Reference
Second Reference Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Volunteer Covenant
The following are the general and specific expectations for those who are participating in all camps, conferences, and other events sponsored by the Christian Church in Florida (Disciples of Christ). By signing below you (the volunteer) agree to the following:

• I will take part in all camp activities and remain on The Retreat at Silver Springs grounds from beginning to end.

• I will cooperate with all camp leaders and obey the rules set for my particular event.

• I will respect each and every person attending my particular camp, treating all people equally and with dignity.

• I will be responsible for the cleanliness and condition of all areas in which I am participating. (Graffiti, carving, cutting, mutilating, vandalizing, etc. will NOT be tolerated).

• I understand that language, clothing, and behavior considered offensive, foul, provocative, overtly sexual, belittling, or harmful in any way (as determined by the camp director) will NOT be tolerated.

• I understand that I am not to enter any cabins other than my own; I will respect everyone’s personal space.

• I will NOT bring any electronic devices (cell phones, radios, stereos, personal listening devices, games, tablets, televisions, etc.) to any event. Such items will be confiscated and returned at the camp’s conclusion.

• I will NOT use tobacco products, alcohol, or any non-prescribed drugs during any camp.

• I will NOT bring fireworks, firearms, knives, or any other weapons to any camp.

• I understand telephone calls are only for emergency situations arranged by the director.

• If it is illegal, I cannot do it or have it.

• I will lock my vehicle and turn over all my keys to the director at registration.

• I will relay immediately to the director any problems involving campers, conferees, or counselors. The director will have responsibility to handle those situations as needed.

• I will encourage all participants to maintain our covenant agreement and will not encourage breaking this covenant either by spoken or unspoken permission.

• If I pose a real or perceived threat to any other person, the camp site, or myself, I may be sent home immediately at the director’s discretion.

• I understand staff will have zero tolerance for offenses against this covenant.
Checking this box represents your digital signature and authorization. You cannot apply to volunteer without accepting the "Volunteer Covenant".
Applicant Name*
Date

MonthDayYear
Date
We appreciate the investment of your time and talents that make Outdoor Ministry for FL Disciples possible. If you would like to support this ministry financially, know that it costs $65 per day per volunteer. If you or someone who loves you would like to make a donation to cover this expense, know it will be appreciated! Donations can be made at www.fldisciples.org/giving/ and select “Outdoor Ministry Support”
Volunteer Certificate of Good Moral Character
As an applicant for consideration as a camp counselor and/or director with the Christian Church (Disciples of Christ) in Florida, I hereby attest to meeting the requirements for volunteer service, that I am of good moral character, that I have not been found guilty of, or entered a plea of nolo contendere or guilty to , any offense prohibited under any of the following provisions of the Florida Statutes or under any similar statute of another jurisdiction. I have not had a finding of delinquency or entered a plea of nolo contendere or guilty of a petition alleging delinquency pursuant to Part II, Chapter 39, Florida Statutes, or similar statutes of other jurisdictions, for any of the following acts.

Section 415.111 abuse, neglect or exploitation of aged or disabled persons

Section 741.30 domestic violence

Section 782.04 murder

Section 782.07 manslaughter

Section 782.071 vehicular homicide

Section 782.09 killing of an unborn child by injury to the mother

Section 784.011 assault, if the victim of the offense was a minor

Section 784.021 aggravated assault

Section 784.03 battery, if the victim of the offense was a minor

Section 784.045 aggravated battery

Section 787.01 kidnapping

Section 787.02 false imprisonment

Section 787.04 moving children from the state or concealing children contrary to court order control

Section 794.011 sexual battery

Section 794.041 prohibited acts of persons in familiar or custodial authority

Chapter 796 prostitution

Section 798.02 lewd and lascivious behavior

Chapter 800 lewdness and indecent exposure

Section 806.01 arson

Section 812.13 robbery

Section 817.563 fraudulent sale of controlled substances only if the offense was a felony

Section 826.04 incest

Section 827.03 aggravated child abuse

Section 827.04 child abuse

Section 827.05 negligent treatment of children

Section 827.071 sexual performance by a child

Chapter 847 obscene literature

Chapter 893 drug abuse prevention and only if the offense was a felony or if any other person involved in the offense was a minor

I further attest that I have not been judicially determined to have committed abuse or neglect against a child as defined in s.39.01, Florida Statutes; nor do I have a confirmed report of abuse, neglect or exploitation as defined in s.415.102, or abuse or neglect as defined in s.415.503 which has been uncontested or upheld pursuant to the procedures provided in s.415.103 or s.415.504, Florida Statutes.

Under the penalty of perjury, I attest that I have read the foregoing, and the facts alleged are true to the best of my knowledge and belief.
Checking this box represents your digital signature and attest to be true that I meet the requirements for volunteer service. You cannot apply to volunteer without meeting these requirements.
Applicant Name*
Date*

MonthDayYear
Date
Background Check Policy
I understand that the Dept. of Children and Families of the State of Florida requires criminal backgrounds checks on all volunteer applicants who are working in any summer camp event at The Retreat at Silver Springs or at any other location. I understand I will be provided with information needed to initiate that background check through DCF and that it is my responsibility to have the background check completed three weeks prior to the camp in which I intend to serve.
Signature
I have read and understood the Volunteer Covenant, Volunteer Certificate of Good Moral Character and Background Check Policy. I understand photographs that include myself could be taken at this event and consent for their use in future promotional materials. In case of a medical emergency, I hereby give permission to the physician selected by the Event Director to hospitalize, secure proper treatment for, and to order injections, anesthesia and/or surgery. I also release the Christian Church (Disciples of Christ) and its agents from liability in injuries beyond the limits of the health and accident insurance provided for in the event fee.
Signature*
Date*

MonthDayYear
Date
Should be Empty:

2026 Summer Camp

Volunteer Information

Talents, Gifts, Ministries

Camp Preference

Health Information

Insurance Information

Medications

Emergency Contact Information

Additional Comments

References

Volunteer Covenant

Volunteer Certificate of Good Moral Character

Background Check Policy

Signature