Prairie Camp / Summer Camp / Counselor App

I AM APPLYING FOR:

Summer Camp Counselor

Teen Camp Counselor

First Name

Last Name

Mailing Address (street, city, state, zip)

Female

Male

Date of Birth (mm/dd/yyyy)

Cell Phone

Email address (we will use this to contact you)

Church currently attending

How long have you been attending the above church?

Parent(s) Name

Parent(s) Phone

Your Social Security Number

T-Shirt Size

Do you have any physical, mental, or medical impairment or disability that would limit your performance as a counselor?

Yes

If yes, please explain::

Have you at any time ever been arrested for any reason?

Yes

Have you at any time ever been convicted of, or pleaded no contest to, any crime?

Yes

Have you at any time ever engaged in, or been accused of, any child molestation, explolitation, or abuse?

Yes

Are you aware of having any traits or tendencies that could pose a threat to children, youth, or others?

Yes

If your answer to any of the previoius four questions is yes, please explain in detail:

When and how did you become a Christian?

What has God been teaching you lately?

As briefly as possible, write out the plan of salvation as you would share it with a child:

REFERENCES (one must be your pastor or youth pastor and none may be relatives)

Reference: Pastor/Youth Pastor Name

Email address

Home address (street, city, state, zip)

REFERENCE #2: Name

Relationship to you

Email address

Home address (street, city, state, zip)

REFERENCE #3: Name

Relationship to you

Email address

Home address (street, city, state, zip)

SUMMER CAMP APPLICANT ONLY

(CONTINUE SCROLLING FOR TEEN CAMP APPLICANT)

PLEASE INDICATE EVERY CAMP YOU WILL BE AVAILABLE:

Junior/Preteen Camp (grades 3-6): June 10-14

Rookie Camp (grades K-2): June 17-19

Wilderness Camp (grades 7-9): June 24-29

Interview Dates:

Saturday, April 20, 9 a.m. - 12:00 p.m. @ Missionary Church North Central District Office

Monday, April 22, 6:00 p.m. - 8:00 p.m. @ Sufficient Grounds, Bethel College

Counselor Training (mandatory)

Friday, May 17, 5 p.m. - Sunday, May 19, 12:00 noon @ Prairie Camp

TEEN CAMP APPLICANT ONLY

July 14-20

I prefer to be a counselor for:

Middle School (6-8)

High School (9-12)

Interview Dates:

Monday, March 18, 6:00 p.m. - 9:00 p.m. @ Sufficient Grounds, Bethel College

Saturday, April 20, 9:00 a.m. - 12:00 p.m. @ Missionary Church, North Central District Office

Counselor Training:

Friday, July 13, 8 p.m. at Prairie Camp (be prepared to stay through the end of Teen Camp)

CONTINUE TO THE END FOR ALL APPLICANTS

APPLICATION VERIFICATION & RELEASE

As a counselor of Prairie Camp, I agree that I will not use the premises or any camp activity, on or off the campus, for any purpose contrary to the mission, purpose, or belief of Prairie Camp and the Missionary Church, Inc., which is a biblically-based religious institution.

I realize that Prairie Camp is relying on the accuracy of the information I have provided. I certify the information contained in this application is true, correct, and complete. I authorize Prairie Camp to contact any person listed. I voluntarily release Prairie Camp from liability involving the communication of information relating to my background and/or qualifications and I further authorize Prairie Camp to conduct a criminal background investigation, if such a check is deemed necessary.

APPLICANT: Type first and last name as signature agreeing to the above

If applicant is under the age of 18, a parent must sign and date below.

PARENT: By typing my first and last name below, I acknowledge that I am the parent of the applicant and that all the information provided is accurate.

Prairie Camp Counselor Application