Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
I hereby consent for the State Director's office to seek from local law enforcement any information which pertains to any record of conviction
contained in its files or in any criminal file maintained on me whether local, state, or national. I hereby release the Police Department from any and
all liability resulting from such disclosure.
Please Print
Name: _____________________________________________________________________________________
First
Middle
Last
(Maiden)
Address: ___________________________________________________________________________________
Applicants Statement
The information contained in this application is correct to the best of my knowledge. I authorize any references of churches listed in this application
to give you any information (including opinions) that they may have regarding my character and fitness for youth camp work. In consideration of
the receipt and evaluation of this application by the Church of God, I hereby release to any individual, church, youth organization, charity, employer,
reference, or any other person or organization, including record custodians, both collectively and individually, from any and all liability for damages
of whatever kind or nature which may at this time result to me, my heirs or family, on account of compliance or any attempts to comply with this
authorization. I waive any right that I may have to inspect any information provided about me by any person or organization identified by me in this
application.
Should my application be accepted, I agree to be bound by the bylaws and policies of the Church of God and to refrain from any unscriptural
conduct in the performance of my services on behalf of the church. I also agree to participate in the training and enhancement provided by the
State Director's office in preparation of my participation this summer. (This training will begin Sunday evening prior to the first week of camp and is
MANDATORY for all workers!)
In the event of an accident or serious illness, I hereby give my consent for diagnosis or treatment to be rendered to me from qualified medical
personnel, both on and off campus, should such action be necessary in the opinion of camp officials.
How long have you lived at this address? ____________ If less than two years, give previous address below.
I further state that I HAVE CAREFULLY READ THE FOREGOING RELEASE AND KNOW THE CONTENTS THEREOF AND I SIGN THIS RELEASE AS
MY OWN FREE ACT. This is a legally binding agreement which I have read and understand.
_________________________________
______________________________
________________________
Applicant's Signature
Witness Signature
Date
*PLEASE ENCLOSE A PASSPORT SIZE PHOTO, OR PICTURE I.D., WITH THIS APPLICATION*
NO APPLICANT CAN BE ACCEPTED WITHOUT THE COMPLETED SIGNATURE ENDORSEMENT FORM OF THEIR LOCAL
CHURCH PASTOR. PLEASE HAVE YOUR PASTOR FILL OUT THE FORM AND SEND IT IMMEDIATELY.
Must be at least 15 years of age Cabin Leaders must be 18 + Must be a regular attendee of a local church Endorsement Form completed and
signed by your pastor Complete and submit the Screening Form and Application.
PositionsForWhichYouMayApply
ToworkincamponemustbeacommittedChristianatleast15yearsofage.SeniorCampworkersmustbeatleast19.Inyoungercamps,alimited
numberofteenagers,ages1518maybeacceptedprovidingtheyareneeded.Prioritywillbegiventoadultworkers.NoworkershouldreporttocampwithoutcontactfromtheStateYouthDepartment.
WHAT IS A CABIN LEADER?
A Cabin Leader accepts the challenge to care for a group of campers. A Cabin Leader must be patient, gentle, fair, firm, consistent, and able to lead.
Each Cabin Leader may select an assistant leader of their choice, provided he/she completes a worker's application and is qualified (workers under
age eighteen may be allowed to work as an Assistant Cabin Leader).
WHAT IS A STAFF MEMBER?
A staff member may request a particular assignment such as night security, kitchen staff, etc. However, it is important to understand our youth camp
"team" approach. Every staff member must be willing to accept daily assignments according to camp needs. Staff members often assume additional
duties and are called upon to assist in other areas.
A. Will your child be a camper the same week you will work?
If yes, do you want your child to be in your cabin?
C. Do you suggest a qualified person to assist you?
Yes
No
No
Yes
No
No
Yes
No
________ Camp(s):
__________
__________
________
________
________
________
NORTHERN REGION
Senior High / June 25-29 (Ages 14-17)
Kids Camp / July 1-4 (Ages 7-10)
Intermediate / July 4-7 (Ages 11-14)
________
________
________
WhilenooneisrejectedtoworkorattendChurchofGodyouthcamponthebasisofrace,color,orcreed,thestatedirectorofyouthandChristianeducationandcampofficialsreservetherightto
Date Postmarked:
SOUTHERN REGION
Senior High / June 11-15 (Ages 15-17)
Junior High / June 18-22 (Ages 12-14)
Kids Alive / June 25-29 (Ages 10-12)
Adventure Time / July 2-5 (Ages 7-9)
________ _______________________
acceptorrejectanyapplicationforvolunteerworkatcampsafterreviewofsaidapplicationrevealsthattheservicesoftheapplicantwouldorwouldnotbeinthebestinterestandsuccessofthe
camp.Thisapplicationisgiveneveryconsideration,butitsreceiptdoesnotimplythattheapplicanthasbeenacceptedforcampworker.Applicantsareacceptedona"trialbasis"andifthe
applicant/workerisnotadaptabletotheassignmentandcannotbereassigned,orthatinformationgivenhasbeenmisrepresented,theacceptanceofthisapplicationcanbeterminatedwithout
othercauseornotice.Inaddition,investigationwillbemadeastotheapplicantscharacter,generalreputation,personalcharacteristics,andadaptabilitytotheparticularpositiontobeassigned.All
applicantsarerequiredtoundergotraining/orientationprovidedbytheSateYouthandCEdirector'sofficeandunderthesupervisionoftheStateYouthandCEboard.Applicantsarenotrequired
toprovideinformationwhichisprohibitedbyFederal,State,orlocallaw.
PERSONAL INFORMATION:
County
Name of the pastor and name of the church of which you are a member:
______________________________________________________________________________________________________________
State
Height: ___________ Weight: __________ Hair: _____________ Eyes: ___________ Race: _______________
Have you ever been convicted of or pleaded guilty to a sexual assault, sexual abuse or child abuse?
Have you ever been charged, arrested, convicted of, or pleaded guilty to any crime?
List (name) other churches you have attended regularly during the past five years: _______________________________________
List all previous church work involving youth (list each organization's name / address, type of work performed, and dates) :
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
List any gifts, training, education, or other factors which have prepared you for work in youth camp.
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
Have you ever been accused, charged, or alleged to have committed any act of
neglecting, abusing, or molesting a child or youth?
You may discuss the answers to the previous questions with a pastor or ministry leader. Answering Yes or leaving it
unanswered will not automatically disqualify you from the privilege of working. You may be asked to clarify your response.
Have you ever been involved in homosexual activity?
Have you ever been accused, charged or alleged to have committed a theft?
What parts of the camp position/work do you most look forward to?
______________________________________________________________________________________________________________
Have you previously worked in Ohio Youth Camps? What year(s) ? Doing what?
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
(If answered YES to any of the above questions and would like to give us a clearer picture of your background / history, please
explain below (attach a separate page if necessary). If answered YES to any of the above questions, would you be willing to
discuss this matter with a pastor or ministry leader? __________________________________________________________________
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
EDUCATIONAL BACKGROUND:
Junior High (Grades 7-9): ________ High School (Grades 10-12): ________ College (1-4): _________ Graduate School: _________
PERSONAL REFERENCES
Name _______________________________________
Address _____________________________________
_____________________________________________
Telephone (
) _______________________________
Do you have a current driver's license? (some form of picture ID may be required)
If you are under the age of 18, please have your parent sign this medical release below:
YES
NO
In the event my child __________________________ needs emergency medical attention, I hereby give my consent for the officials of
the camp to seek such medical assistance. I further understand that the camp will make every attempt to notify me of such action as
soon as possible.
*PLEASE ENCLOSE A PASSPORT SIZE PHOTO, OR PICTURE I.D., WITH THIS APPLICATION*
Date ________________________________