Name

Mailing Address

City

State

Zip Code

Home Phone Number (With Area Code)

Work Phone Number (With Area Code)

Cell Phone (With Area Code)

* Email Address

Date of Birth

Sex
Please select: Male Female

Marital Status
Please select: Married Single

In case of emergency, please notify:

Telephone Number of Person to be Notified

Why do you want to be a counselor?

Which camp do you wish to minister?
Please select: Middle School (6/15-20) High School (6/8-13)

Name of Your Church

Are you a member of your church?
Yes No

Size of Group Your Anticipate to Bring

Please write a brief testimony with regard to your relationship with Jesus Christ:

What qualities do you have that would make you a good counselor?

Have you had experience leading Bible studies?
Yes No

How would you explain what a Christian is to a young child or teen with little or no understanding of Christianity?

What would you do if a student wants all your attention?

What would you do if a student asks about Satan or hell during Bible study?

What would you do if a students tells you that another student is bullying him/her?

Legal Question #1: Have you even been arrested for or charged with a sexual offense related to children, or a crime of violence?
Yes No

Legal Questions #2: Have you ever been reported to a social services agency, law enforcement authority, child abuse registry, or similar organization regarding abuse or misconduct involving children?
Yes No

Legal Questions #3: Have you ever been subjected to expulsion, reprimand, or other discipline by a church, denomination, or other religious organization?
Yes No

Legal Question #4: Have you ever been the subject of a civil lawsuit involving sexual misconduct, sexual harassment, or other immoral behavior or conduct involving adults or children?
Yes No

Legal Question #5: Have you even been the subject of any disciplinary action, transfer, or dismissal or been named as a defendent in a civil lawsuit as a result of an accident or mishap involving children?
Yes No

If your answer was "Yes" to any of the previous legal questions, for each positive response, please provide the following information: 1) Date and complete description of the circumstance 2) Name and address of the church, employer, or other organization

By typing your full name in the box below, you are signifying that you have read all of the sounselor information, have filled out the application and the legal portion of the questionnaire, and that you understand your responsibility and role as a camp c

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