Returning Staff TRAC Application

TEEN REACH ADVENTURE CAMP CAMP COUNSELOR/STAFF APPLICATION
TEEN REACH
Girl's T.R.A.C.: 7/19/2024 to 7/21/2024

Boy's T.R.A.C.: 7/26/2024 to 7/28/2024
Date*

MonthDayYear
Date
Name*

First NameLast Name
Street*
City*
State*
Cell Phone*
Home Phone
Email*
example@example.com
Birth Date*

MonthDayYear
Date
Sex*
Marital Status*
Living Situation*
Emergency Contact*
Phone Number*
Do you need or want a new T-Shirt this year? If so, please mark what size below:

YesNo
T-Shirt Size

Adult SmallAdult MediumAdult LargeAdult X-LargeAdult XX-Large:OtherWomen's style/cut
Have you ever been abused, neglected, or abandoned?*

NoYesYes, but prefer to discuss in person.
Do you have a certification in the following?

CPR NurseFirst AidLifeguardNurseEMT
Have you ever served at another Teen Reach Adventure Camp program?*

YesNo
If YES, what was the location of the Teen Reach Adventure Camp? If NO, please put N/A.*
Why do you wish to continue volunteering at T.R.A.C.?*
Do you have any medical conditions?*

YesNo
If yes, please explain
Do you take any medications?*

YesNo

Please list:

Has anything changed in your life in the past year, personally or professionally?*

YesNo
If yes, please explain:
In the past year, have there been any changes in your legal record?*

YesNo
If yes, please explain:
In the past year, have you been accused or convicted of any sexual misconduct? If*

YesNo
If yes, please explain
In the past year, have you ever taken drugs other than prescriptions?*

YesNo
If yes, please explain:
How has God been growing you over the past year?*
I have read, agree with, and will comply with the Teen Reach Statement of Faith, Volunteer Standards, and Position Statement. *Scan the QR code or follow hyperlink.*

YesNo
Statement of Faith
I am interested in becoming a mentor.*

YesNo
I certify, under penalty of perjury, that my signature below signifies this information is true and correct to the best of my knowledge. I give permission for T.R.A.C. to request background checks for me to become a staff member/camp counselor for Teen Reach Adventure Camp.
Name (please print)*
Signature*

Clear
Date*

MonthDayYear
Date
Should be Empty:

TEEN REACH