There are a few things we need from you to make sure we are able to create the best camping environment possible:

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Sydney Haynes
5 years ago
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1 Dear Counselor Applicant: The WAPAC Kid s Camp Team would like to thank you for offering your time to make a difference in the lives of children during the week of camp. Being a counselor is an awesome privilege and carries some great responsibilities. During these five days, you are the greatest influence in the lives of these boys and girls. As leaders, we do not always have the background information on each child who walks on to the campus; however, we realize we live in a broken world. Some of the kids attending camp will come with life struggles and other hardships. You have the amazing opportunity to be the hands and feet of Jesus this week and share the love He so graciously extends to us. Again, thank you for your time. We realize that there are many sacrifices being made on your part to be available as a counselor. There are a few things we need from you to make sure we are able to create the best camping environment possible: 1. Begin right now by praying with us for the kids who will be assigned to your cabin. Pray for safety, open hearts, and clear minds during the week of camp. Pray for the speaker and worship leaders that God would use them to prepare the hearts of kids and counselors. Pray for yourself and other counselors that God will strengthen you both spiritually and physically for the week of camp. 2. The following pages of this application need to be postmarked by June 17, 2015 in order to run the appropriate background checks and get you set up for the MinistrySafe online training. 3. MinistrySafe is an online sexual abuse awareness training video that will help establish safe and consistent understandings of how we will operate as a camp team. We will do additional training at the campground, but the completion of MinistrySafe is nonnegotiable. This online training will need to be completed by midnight, July 8th. Due to the content of MinistrySafe, please look in your junk for the training link since some filters may flag it as improper content. 4. All applications need to be signed off from a Senior Pastor, Children s Pastor, or board member who is not related to the applicant. 5. We are asking that the cost of the counselors be covered by the local churches. In our experience, a simple ask from the congregation is more than enough to cover what is needed to send students and adults to camp. The price for a counselor is $250 with no applicable late fees. Counselor scholarships available upon request. Please jmatthews@pnconline.org for scholarship assistance. 6. All counselors are asked to arrive 30 minutes early on Monday, July 7th so that they are available to start receiving kids as churches arrive (more instructions to follow as camp gets closer). 7. All counselors are asked to be present until all of their campers have been signed out on Friday, July 17th. 8. The act of submitting an Adult Counselor Registration Form does not automatically mean you are accepted to be a counselor. Once all of the necessary parts of the application process are in order, you will be sent an from the leadership team with more details. Please respond to the verifying your acceptance. This is going to be an INCREDIBLE week of camp and your participation is key. We cannot thank you enough for you willingness to serve the district and more importantly, our kids. - WAPAC Kids Camp Leadership Team

2 WAPAC Kids Camp at Miracle Ranch July 13, 2014 July 17, 2015 Washington Pacific District Kids Camp 2015 Forms must be postmarked by June 17th! WAPAC Kids Camp: July 7, 2014-July 11, 2015 $250 *Counselor scholarships available if needed* Name: Age: Birthday*: LAST FIRST MIDDLE *(YOU MUST BE BORN BEFORE JULY 13, 1994 TO BE A COUNSELOR FOR WASHINGTON PACIFIC DISTRICT KIDS CAMP) *(YOU MUST BE BORN BEFORE JULY 13, 1997 TO BE A JR. COUNSELOR FOR WASHINGTON PACIFIC DISTRICT KIDS CAMP) Male Female Church: T-Shirt Size: XXL XL L M S Address: City: State: Zip: Phone: Medical Insurance Company: Policy #: Emergency Contact: Physician: Phone: (Home) (Cell) Office Phone: Medical History If necessary, describe in detail the nature and severity of any physical and/or psychological ailment, illness, propensity, weakness, limitation, disability, or condition to which you are subject and of which the staff should be aware, and what, if any action of protection is required on account thereof. Submit this notification in writing and attach it to this form. Include names of medications and dosages that must be taken. Check the following areas of concern for this person. If necessary, add another page with details: 1. Do you have allergies to pollens medications food insect bites other Please explain: 2. Do you suffer from, or have ever experienced, or are being treated currently for any of the following: asthma epilepsy/seizure disorder heart trouble diabetes frequently upset stomach physical handicap other Please explain: 3. Date of last tetanus shot: 4. Please list and explain any major illnesses you have experienced during the last year: Additional comments: Children s Ministry Experience What local church do you attend? yes no Are you a member of that local church? Year received? yes no Have you received Christ as your Savior? Year? yes no Have you ever led anyone to Christ? yes no How long have you been working with children? In what capacity do you currently serve?

3 Personal References Please provide two personal references. No relatives please. Name: Name: Address: Address: City/State: City/State: Phone: Phone: Relationship: Relationship: Applicant Statement: The information contained in this application is correct to the best of my knowledge. I authorize any references listed in this application to give you any information they may have regarding my character and fitness for children s ministry. I release all such references from liability for any damage that may result from furnishing such evaluations to you and I waive any right that I have to inspect the references provided upon my behalf. Should my application be accepted, I agree to be bound by the constitution, by-laws and policies of the Washington Pacific District Church of the Nazarene and to refrain from unscriptural conduct. Signature: Date: This consent form gives permission to seek whatever medical attention is deemed necessary, and releases Washington Pacific District Church of the Nazarene and its representatives of any liability against personal losses of named person. I understand that there are inherent risks involved in any ministry or athletic event, and I hereby release the Washington Pacific District Church of the Nazarene, its pastors, employees, agents, and volunteer workers from any and all liability for any injury, loss, or damage to person or property that may occur during the course of my involvement. In the event that I am injured and require the attention of a doctor, I consent to any reasonable medical treatment as deemed necessary by a licensed physician. In the event treatment is required from a physician and/or hospital personnel designated by the Washington Pacific District Church of the Nazarene, I agree to hold such person free and harmless of any claims, demands, or suits for damages arising from the giving of such consent. I also acknowledge that we will be ultimately responsible for the cost of any medical care should the cost of that medical care not be reimbursed by the health insurance provider. Further, I affirm that the health insurance information provided above is accurate at this date and will, to the best of my knowledge, still be in force for the person named above. Signature: Date: PASTORAL RECOMMENDATION I wholeheartedly recommend as a potential staff member for the WAPAC District Kid s Camp Feel free to contact me if you have any questions or concerns regarding this individual. Pastor s Signature: Date: Pastor s Name (printed): Address: City: State: Zip: Phone: Please mail completed forms to: Ridgefield Church of the Nazarene Attn: JJ James P.O. Box 118 Ridgefield, WA *Forms must be postmarked by June 17th!*

4 WASHINGTON PACIFIC DISTRICT CHURCH OF THE NAZARENE RELEASE OF RECORDS Department or Ministry: Children s Camp Washington Pacific District Church of the Nazarene Name: Last First Middle Alias Name/Maiden Name: Social Security #(REQUIRED): Address: Street City State Zip Previous Address: Street City State Zip Birth Date (REQUIRED): Race: Sex: M F Month/Day/Year Driver s License #: State: Expiration Date: I,, give permission to the District Advisory Board of the Washington Pacific District Church of the Nazarene to do a background check about any possible criminal history I might have. I understand that this information will be held in confidence and not released to any outside sources. Please answer yes or no to the following questions. If your answer is yes, please explain. Has a civil lawsuit alleging actual or attempted discrimination, harassment, exploitation, physical abuse, child abuse, or moral misconduct ever been filed against you, whether or not it resulted in a judgment being entered against you, was settled out of court, or was dismissed? Have you ever terminated your employment or service in a volunteer position or had your employment or authorization to hold a volunteer position terminated for reasons relating to allegations of actual or attempted discrimination, harassment, exploitation, physical abuse, or moral misconduct? Is there any fact or circumstance involving you or your background that will call into question you being entrusted with the responsibilities for which you are applying? Are you required to register with any state for any criminal or sexual offense? Have you ever used an illegal substance or abused alcohol or other substance? Have you ever been convicted of a criminal offense other than a minor traffic violation? Signature of Applicant Date Form must be received with application by June 17 th!

5 Agreement for Waiver and Release, Assumption of Risks & Indemnification (rev 1/10) NOTICE: This document affects your legal rights, please read carefully. Handwritten changes to this document are not permitted and will not be honored. This Agreement constitutes the entire Agreement and shall not be modified except via written document, executed by both parties. If any portion of this Agreement is found to be void or unenforceable, the remaining portions shall remain in full force and effect. Group or Event Name WAPAC Kids Camp July 13 th 17 th Participant Name (print) Parent/Legal Guardian Name (print) I, the above Participant or the Parent/Legal Guardian of participant, being above the age of 18, agree as follows: I acknowledge and understand that certain camping activities, including but not limited to: skating, skateboarding, paintball, ropes courses, archery, marksmanship, water sports, horses and dirt bikes are hazardous and dangerous activities that require strenuous exercise and varying degrees of skill and experience. I understand that these activities can result in serious injury to the person and damage to property and I voluntarily assume any and all risks of loss, damage or injury while on the premises. I acknowledge that there are risks, hazards and dangers of personal injury, death and disability inherent in entering camp grounds and participating in, or viewing camp activities. I am aware that the usual risks, hazards and dangers of personal injury, death and disability increase when using certain camping equipment and when other persons, whether of the same or different level or experience or skill, are using the same facilities and equipment. In consideration for my participation, or for the participation of my child or the minor for whom I represent that I am legal guardian, I hereby release and forever discharge Island Lake Camp, Miracle Ranch Camp, and CRISTA Ministries, and their servants, employees, officers, directors, trustees and all other persons or entities acting on their behalf (collectively referred to as CRISTA ), from any and all claims, actions, damages, liabilities, costs or expenses and attorney fees which are related to, arise out of, or are in any way connected to my, my child s, or the minor for whom I represent that I am legal guardian s viewing or participating in any camping activities. By signing this Agreement, it is my intention to waive any rights to sue or seek damages from CRISTA; except where injury, death or disability results from CRISTA s gross negligence. I further agree to indemnify, hold harmless and defend CRISTA against any and all claims for damages, costs, expenses or attorney s fees brought by any third party in connection with or arising out of my, or the above-listed participant s involvement or participation. This Agreement shall be effective and binding upon my marital community, estate, heirs, agents, personal representatives and assigns. Emergency Consent: (participant s name) may receive emergency and/or routine medical care from a physician or emergency facility if I am incapacitated (if participant), or cannot be reached in an emergency (if parent/guardian). Photo Release: CRISTA may publish photos taken of participant and I release all rights to remuneration for such photos. I hereby certify that I am 18 years of age; I have carefully read the foregoing and acknowledge that I understand and agree to all the terms and conditions. I have had the opportunity to ask any and all questions regarding this Agreement and the effect of the same. I am aware that by signing this Agreement, I assume all risks and waive and release certain substantial rights that I have or possess. Participant Signature (on behalf of marital community) Parent/Legal Guardian Signature Date: Date: Additional Indemnification for Parents/Guardians Must be completed for participants under the age of 18. In consideration of s (print minor s name) ( Minor ) participation in Camps activities including the use of Camps equipment and facilities, I further agree to indemnify and hold CRISTA harmless from any and all claims which are brought by, or on behalf of Minor and which are in any way connected with such use or participation by Minor. Parent/Legal Guardian Signature (on behalf of marital community) Date:

VACATION BIBLE CAMP PARTICIPANT REGISTRATION FORM We are headed to a new camp location this year!

Need Help? Have Questions? Email: vacationbiblecamp@thenbcf.org 425.282.6220 VACATION BIBLE CAMP PARTICIPANT REGISTRATION FORM We are headed to a new camp location this year! Crista Camps- Miracle Ranch