2018 ADULT (18+) CAMP STAFF APPLICATION

Transcription

1 2018 ADULT (18+) CAMP STAFF APPLICATION For security purposes, please staple a photo of yourself. NAME FIRST MIDDLE LAST CHURCH & CITY AGE REQUIREMENTS: STAFF: Applicants must have completed High School. CABIN STAFF: Applicants must be 21-years-old for Senior Teen Camp and 18-years-old for Junior Teen Camp. BEFORE SENDING APPLICATION TO THE NETWORK OFFICE, BE SURE YOU: Signed in all locations needed Complete all information and questions Staple a photo of yourself Obtain personal and pastoral references including a pastoral signature (Not Signed by Applicant) Filled out the date of last background check (cannot be older then 2 years) JUST A REMINDER: Deadline for Staff Application - Postmarked by June 15 (GLACIER CAMPS) July 1 (BSKC). After this date, please mt.student.ministries@gmail.com for potential availability. If deadline has passed please contact the Network Office Please do not show up at camp unless you have received prior approval. Unapproved staff may have to pay the full tuition price of camp due to the cost of having extra people on the campground. Thank you for your understanding and cooperation. Print clearly - form must be completed and signed by all parties, otherwise applications will not be processed and be sent back. CONTACT INFORMATION: Please print clearly, ALL fields are required. Name First Middle Last Marital Status Gender at Birth Age Birthdate (MM/DD/YY) Mailing Address (No PO Box) City State Zip Cell Phone Number Address FOR OFFICE USE ONLY Date Received Approved Camp Position Check # Letter Sent (Pastoral) Background Check 1

2 2018 ADULT (18+) CAMP STAFF APPLICATION Choose Either Cabin Staff or Staff for Your Chosen Week CABIN STAFF Senior Teen (July 9-14) must be 21 Glacier Kids (July 16-20) must be 16 Junior Teen (July 23-28) must be 18 Big Sky Kids (July 30- August 3) must be 16 STAFF ASSIGNMENT Please number 1-3 in order of the positions you desire. But please be ready to serve where needed. Where needed most Recreation Office Security (must be 21 or older) Nurse (LPN, RN or EMT) Kitchen Pots and Pans STAFF DATE Senior Teen (July 9-14) Glacier Kids (July 16-20) Junior Teen (July 23-28) Big Sky Kids (July 30- August 3) STAFF PREPARATION: Have you previously served at camp? Yes No If so, how many years? Positions held? Background Check Date Completed: If not staying with students, have you secured housing on the camp grounds? If, yes, where will you be housed at? Cabin or RV LOT # By signing below, I understand, agree with, and am willing to abide by the Glacier Bible Camp and/or Eastern Montana Bible Camp Guidelines and Camp rules. Lack of cooperation, unnecessary roughness, lack of respect for property, unlawful activity or an unwholesome attitude on the part of any Participant will result in expulsion from camp. I understand that the of the Assemblies of God reserves the right to refuse my application to attend and serve camp for any reason. X applicant signature PERSONAL INFORMATION: Church Now Attending City Yes No I have been born again and know my salvation is real. Salvation Date: Yes No Have you been baptized in the Holy Spirit with the evidence of speaking in tongues (Acts 2:4) Baptism Date: Yes No Do you currently use tobacco? Yes No Do you drink alcoholic beverages? Yes No Do you use illegal drugs? Yes No Have you been found guilty of a crime as an adult? Yes No Have you ever been the subject of an investigation for child abuse, neglect or endangerment? If yes, please explain. ADULT APPLICATIONS MUST BE RECEIVED IN THE NETWORK OFFICE BY June 15 (GLACIER CAMPS) July 1 (BSKC). If approved you will receive an of acceptance (where applicable) and we will be expecting you at the camp(s) for which you have applied. If you prefer a postal mail acceptance letter instead of , please specify: Postal Acceptance Letter Y / N Your room and board will be provided (bring your own bedding) but you are responsible for your own transportation. Please notify us if you are unable to fulfill your commitment. (Network Office: ) Because we want to give full consideration to our campers and staff, and because there is no insurance coverage for them, no children who are not campers will be allowed in the rental space of the campgrounds during Senior, Junior, and Kids Camps. Thank you for your cooperation. EMERGENCY CONTACT INFORMATION: Emergency Contact Relationship to Participant Daytime Phone: Cell Phone: 2

3 PASTORAL REFERENCE CERTIFICATION 2018 ADULT (18+) CAMP STAFF APPLICATION CHURCH HISTORY: Do you or your spouse hold Assemblies of God Ministerial Credentials? You Spouse Current church staff position: Your position: Full time Part-time Volunteer Spouse s position: Full time Part-time Volunteer List names and addresses of other churches you have attended regularly during the past five years: List all previous church work involving children: (List church s name and address, type of work, and dates) List all previous non-church work involving children: (List each organization s name and address, type of work, and dates) PASTORAL REFERENCE CERTIFICATION: The senior pastor or other pastoral staff MUST complete this portion. NAME OF STAFF APPLICANT In evaluating the fitness and suitability of each staff applicant, places great reliance on the opinion of those who know the applicant best. Therefore, we are asking the applicant s senior pastor, or other pastoral staff member (choose the one who knows the applicant best) to certify below that there are no facts or allegations that raise any question concerning the applicant's fitness and suitability for working with minors. We also are requesting that the senior pastor, or other pastoral staff member, certify that a background check was performed on the applicant by the applicant s church, if this is the case. Because of the large number of applicants, many of whom are unknown to us, it is impossible for the to check references on every applicant. As a result, it shall be the responsibility of each applicant's pastor, youth pastor, children s pastor, or church board member to certify that there are no facts or allegations that raise any question concerning the applicant's suitability for working with minors. DO NOT USE SOMEONE WHO IS RELATED TO YOU. (Check all that apply) I am personally acquainted with the applicant, and in my opinion, he or she is competent and qualified to work with minors of any age. I know of no facts or allegations that raise any questions concerning his or her suitability for working with minors in any activity. Our church performed a background check on the applicant that included references and a criminal record check within the last 2 years. There was no information suggesting that the applicant poses a risk of harm to minors. I prefer to discuss my response by telephone. I can be reached at the following telephone number during the day: Phone Number: Pastor s Signature Type or Print Name I am: (Please check one) the Senior Pastor other Pastoral Staff: Church Phone Number - - 3

4 STAFF-CAMPER INTERACTION GUIDELINES The heart behind these guidelines is to protect both the camp staff and the camper. Summer Camps are a time for students to come and experience biblical community and grow in their faith. Observing these guidelines will help accomplish both purposes. GENERAL GUIDELINES 1. Camp staff are to model Christ-likeness in all their words, attitudes and actions. 2. Camp staff are to help create an environment of unity by supporting the leadership of Montana Ministry Network camps. 3. Camp staff are never to be alone with a camper. There are no exceptions to this guideline: Groups should always be in a minimum of three. 4. There is to be no physical contact of any kind between a camp staff and a camper. The only exceptions are corporate prayer times, in the case of a medical emergency or allowance for normal types of contact during a game or sporting event that is being played in a public area. 5. Camp staff - camper romantic relationships are not allowed. Any conversations about possible romantic relationships are not allowed. 6. Pranks, bullying, physical intimidation, threats, or violence of any kind between camp staff towards other camp staff and camp staff towards campers is not allowed. This includes pranking the property of campers. Such behaviors are unacceptable and may lead to dismissal from the camp. 7. Camp staff should refrain from any crude joking with, toward or about campers or other camp staff. 8. Camp staff should not make any comments of any kind with regards to the physical appearance or physique of Campers. 9. Camp staff should not make any critical comments about camper s parents, family, church or church leaders. 10. Private communications on social media or via text messages, picture messages or phone calls during or after camp between campers and camp staff is not allowed. The only exception is if the camper attends the same church as the camp staff and that church s social media policy allows for this. 11. Camp staff are to never make fun of, humiliate or bully a student. Nor are they to ever raise your voice or hand towards a student. This type of behavior will not be tolerated and will be dealt with appropriately. 12. Never favor one student over another. Treat all students with equal respect. IN CABIN GUIDELINES 1. Camp staff are to sleep in separate single beds nearest the main exit of the cabin. 2. Camp staff are to never lay on the same bed as a camper. 3. Camp staff should always change clothes in private and never be completely unclothed in the presence of a camper. 4. Camp staff are to give campers complete privacy in the bathroom. This applies to use of toilets and use of showers. 5. Camp staff should not take photographs or video of campers in the cabins. SERVICE GUIDELINES 1. Male camp staff are to pray with guys only. Female camp staff are to pray with girls only. The only exception to this is a student s pastor praying for their students in a public setting (ex. During an altar call). 2. Camp staff should not remove campers to a private area for prayer or ministry. 3. Another camp staff must be present if you feel led to share a word with a camper. 4. Camp staff should not give directive counsel of any kind to a camper in private. 5. Any reports of abuse of any kind or intent to harm self or others by a camper to a camp staff must be reported to the Camp Director immediately. Applicant s Signature Date Printed Name: 4

5 PLEASE PRINT PARTICIPANT S LAST NAME: FIRST NAME: AGREEMENT FOR RELEASE AND ASSUMPTION OF RISK: I understand that I am being asked to read the following agreements carefully. I understand that if I wish to discuss any of the terms contained in this agreement, I may contact the Network Youth Director, Dan Liebe, READ THIS DOCUMENT ("AGREEMENT") CAREFULLY BEFORE SIGNING Participation Agreement IN CONSIDERATION of my acceptance as camp staff at, Glacier Bible Camp or/and Eastern Montana Bible Camp for the activities land risk located in #2 below and other considerations the sufficiency of which is acknowledged, represent and agree that: 1. Status. I attest and certify that I am physically fit and have no medical conditions that would prevent me from participating in the below-referenced activities. 2. Risks of activity. I am aware of the hazards and risks to my person associated with participating in this Camp. Participant named above (the Participant ), does hereby consent to the participation of the Participant in the activities of the 2018 Camps. Activities include, but not limited to outdoor activities in which participants may be subject to hazardous plants and bites from insects, ticks, mosquitos, spiders, and snakes. Other activities include swimming which may involve water and mud, team games such as basketball, volleyball, soccer, and others, recreational games (relay race style, tug-of-war, etc.) Participant represents that Participant is in good health and in proper physical condition to participate in the above-referenced activities. Further, Participant certifies that Participant is physically able and adequately trained to participate in such events, specifically swimming. Participant hereby understand and acknowledge the physical rigors associated with the above-referenced activities and/or use of such equipment and understand that participation involves risks and dangers which include, without limitation, serious bodily injury, permanent disability, disease, strains, fractures, partial and/or total paralysis, eye injury, blindness, heat stroke, heart attack or death, inaccessibility of medical care, dangers arising from adverse weather conditions, inadequate safety measures, participants of varying skill levels, situations beyond the immediate control of, Glacier Bible Camp or/and Eastern Montana Bible Camp, other undefined harm or damage which may not be readily foreseeable, and other presently unknown risks and dangers (collectively the Risks ). Participant understands these Risks may be caused in whole or in part by Participant s own actions or inactions, the actions or inactions of others participating in the activities. I have made my own investigation of these risks, understand these risks, and assume them knowingly and willingly. I understand and agree that if, during my participation in the above-described activities, if I have suffered an injury, or am otherwise in a situation that raises significant health and safety concerns, then a representative of the, Glacier Bible Camp or/and Eastern Montana Bible Camp may contact the person whose name I have provided as my "emergency contact". I understand that the, Glacier Bible Camp or/and Eastern Montana Bible Camp ordinarily will not initiate such contact without first having a discussion with me. GENERAL RELEASE AND ASSUMPTION OF RISK: KNOWING THE RISKS DESCRIBED ABOVE, I AGREE, ON BEHALF OF MY FAMILY, HEIRS, AND PERSONAL REPRESENTATIVES, TO ASSUME ALL THE RISKS AND RESPONSIBILITIES SURROUNDING MY PARTICIPATION IN THE ABOVE-DESCRIBED ACTIVITIES, BOTH KNOWN AND UNKNOWN. TO THE MAXIMUM EXTENT ALLOWED BY LAW, I RELEASE, HOLD HARMLESS, AND AGREE TO INDEMNIFY MONTANA MINISTRY NETWORK, GLACIER BIBLE CAMP or/and EASTERN MONTANA BIBLE CAMP, A AND THEIR OFFICERS, DIRECTORS, EMPLOYEES, VOLUNTEERS, AND AGENTS, FROM AND AGAINST ANY PRESENT OR FUTURE CLAIMS, LOSSES, LIABILITIES, COSTS AND EXPENSES FOR INJURY TO PERSON OR PROPERTY, OR FOR ANY OTHER DAMAGE, WHICH I MAY SUFFER, OR FOR WHICH I MAY BE LIABLE TO ANY OTHER PERSON, RELATED TO MY PARTICIPATING IN SAID ACVITIVITIES (INCLUDING PERIODS IN TRANSIT TO OR FROM MY DESTINATIONS), RESULTING FROM ANY CAUSE, INCLUDING BUT NOT LIMITED TO NEGLIGENCE ON MY PART OR ON THE PART OF ANY OF THE RELEASED PARTIES; PROVIDED THAT THIS RELEASE OF LIABILITY SHALL NOT APPLY TO GROSS NEGLIGENCE OR WILLFUL OR WANTON MISCONDUCT. 1. I expressly waive any defense to the enforcement of any provision of this commitment arising from a claim of lack of consideration and warrant that this commitment constitutes a legal, valid, and binding obligation upon me enforceable against me in accordance with its terms. 2. Invalidation of any one or more of the provisions of this Agreement shall in no way affect any of the other provisions hereof, which shall remain in full force and effect. 3. I expressly agree that this assumption of risk, release, and indemnity agreement is intended to be as broad and inclusive as permitted by law. I further state that I HAVE CAREFULLY READ THIS AGREEMENT AND UNDERSTAND ITS CONTENTS, AND I VOLUNTARILY SIGN THIS AGREEMENT AS MY OWN FREE ACT. I certify that I am age 18 or older. I understand and agree that no oral or written representations can or will alter the contents of this document. This Agreement shall be governed and construed in accordance with the laws of the State of Montana, excluding its choice of law rules, and all claims relating to or arising out of this Agreement, including claims for injuries or wrongful death in any way related to the above-described activities, shall likewise be governed by the laws of the State of Montana, excluding its choice of law rules. Signature Date: (Participant ) 5

6 ADULT (18+) Camp STAFF HEALTH HISTORY FORM AND AUTHORIZATION: PLEASE PRINT PARTICIPANT S LAST NAME FIRST NAME BIRTHDATE GENDER EMERGENCY CONTACT PHONE NUMBER FAMILY PHYSICIAN NAME PHONE HEALTH HISTORY Please check YES or NO to the following questions if the response is YES you will have below to add more detail. Does Participant have CHRONIC HEALTH ISSUES Is Participant taking any form of MEDICATION for any reason? Does Participant have DIET RESTRICTIONS Does Participant have ACTIVITY RESTRICTIONS Date of Last Tetanus Are Participant s immunizations current? Does the Participant sleep walk? Can the Participant swim? INSURANCE Is participant covered by insurance? Camp insurance is accident-only coverage and is secondary to personal insurance. INSURANCE CO. GROUP # SUBSCRIBER # Does Participant have any of the health conditions on the chart below? Check all that apply. CONDITION YES NO CONDITION YES NO 1 Asthma Inhaler? Yes No 7 Bleeding 2 Diabetes Insulin? Yes No 8 Bee Sting Allergy Epi Pen? Yes No 3 Epilepsy/Seizures 9 Peanut/Nut Allergy Epi Pen? Yes No 4 Heart Condition 10 Other Food Allergy Epi Pen? Yes No 5 Orthopedic 11 Drug Allergy Epi Pen? Yes No 6 Fainting 12 Anaphylaxis reaction Epi Pen? Yes No Please list medications, foods, diet restrictions or environmental allergens that Participant is allergic to and the allergy reaction if not mentioned above: Is the Participant presently being treated for an injury or sickness or taking any form of medication for any reason? If yes, please explain: Please list any and all diseases, serious illness, injuries and surgeries the Participant has or has had: Does the Participant have any physical condition or illness which would prevent him/her from participating in rigorous activi ty? If yes, please explain: MEDICATIONS Permission is given for the following over-the-counter medications to Does the Participant require any medications to be administered? be given to Participant as directed per age/weight: If yes, please list below all medications with dosage, frequency/time and reason for dispensing. Acetaminophen Pepto Bismal ***Any personal medications (prescription and/or over-the-counter, including pain meds such as ibuprofen, Ibuprofen Calamine Lotion Tylenol, etc.) MUST be brought in the original bottle to the nurse station to be administered to Participant. All meds must be original container with pharmacy label including patient name, physician name, Benadryl Antibiotic Ointment medication name, prescription number, date prescribed, and dosage.* This DOES NOT include over-thecounter daily vitamins. Robitussin DM Antacid(Tums,etc.) MEDICATION DOSAGE FREQUENCY REASON MEDICAL TREATMENT AUTHORIZATION We, THE PARENTS AND/OR GUARDIANS OF Participant ( Parents ), and Participant (if 18 or over) understand that the undersigned Parents will be notified in the case of a medical emergency involving the Participant. However, in the event that Parents, or either of us, cannot be reached, and/or if Participant 18 or over is unable to make decisions, we authorize the calling of a doctor and the providing of necessary medical services in the event the Participant is injured or becomes ill. We authorize any one or more of the following persons to make emergency medical care decisions on behalf of the Participant, if required by law or a health care provider: Camp director or their authorized designee. Parents and Participant (if 18 or over) understand that, Glacier Bible Camp or/and Eastern Montana Bible Camp or any of their agents, employees, or volunteers, shall not be responsible for medical expenses incurred on the basis of this authorization. We hereby agree to hold harmless, defend and indemnify, Glacier Bible Camp or/and Eastern Montana Bible Camp, its parents, subsidiaries and affiliates, board members, officers, employees, agents and volunteers from all obligations, damages, losses, attorney s fees, defense costs, demands, investigations, actions, liabilities, claims, cross-actions, third-party actions, causes of action, of any kind or nature whatsoever, including the negligence or gross negligence of, Glacier Bible Camp or/and Eastern Montana Bible Camp (collectively claims) that may be asserted by anyone and that has any relation to the Participant to the fullest extent permitted by law. It is our express intention to defend, indemnify and hold harmless, Glacier Bible Camp or/and Eastern Montana Bible Camp from all claims arising out of or resulting from or in any manner relating to the treatment, medical or otherwise, of Participant. We agree to notify, Glacier Bible Camp or/and Eastern Montana Bible Camp in the event of any health changes which would restrict the Participant s participation in any activities. We also understand that, Glacier Bible Camp or/and Eastern Montana Bible Camp representative(s) reserve the right to restrict the Participant from any activity for any reason. A photocopy or facsimile of this authorization shall be as valid as the original. Parent/Guardian Signature: Parent/Guardian Signature: Participant (if 18 or over) Signature: Date: Date: Date: 6