604 Mission Blvd., Jackson, CA 95642
CAMP SAINT SAVA
of the Serbian Orthodox Church
Dear Prospective Camp Staff, Volunteers and Counselors,
Camp St. Sava Needs You! Can you help this year?
The Camp St. Sava Committee has been working diligently to prepare for this year’s camp season.
As usual, camp will begin after the Apostles’ Fast on July 12, 2015
Week 1
Week 2
Week 3
Sunday, July 12 - Saturday July 18 Sunday, July 19 - Saturday July 25 Sunday, July 26 - Saturday Aug. 1 We hope that you will be able to volunteer your time and talent to make this year’s program memorable
for the camp children. On the pages which follow, you will find all of the necessary forms which need
to be submitted to apply to be part of our Camp St. Sava staff.
Volunteers must submit their applications to the camp committee for approval. It is important to note,
however, that each week of camp is administered by different clergy and lay directors. It is the responsibility of these leaders to put together their own team of volunteers to staff their week of camp. It is
advisable, therefore, that you contact directly either the lay director or the clergy director for the week
in which you wish to volunteer to discuss which positions are open. The directors for the three weeks
are as follows:
Week 1 Proto Dusan Bunjevic and Paul Bunjevic ([email protected])
Week 2 Proto Bratislav Krsic and Fr. Steve Tumbas (Temporary Director)
[email protected]
Week 3
Proto George Gligich and Nick Salata ([email protected])
Final decisions about staffing rest with these leaders and not with the camp committee. Each week
we need a kitchen manager, kitchen helpers, arts and crafts teachers, a nurse or physician, dining room
help, evening activities coordinators and, of course, many counselors.
COUNSELORS are responsible for the supervision of the campers throughout the day. They live with
the campers in the dorms, prepare them and lead them in all the activities according to the camp schedule. All counselors must be at least eighteen years of age, baptized Orthodox Christians and willing to
report for training and orientation at 2:00 pm on the Saturday before each week of camp. In addition
to room and board for their week-long services, counselors will recieve an honorarium based on this
sliding scale: First year service, $100; Second year, $150, Third year, $200.
Please note: All COUNSELORS must agree to a background check as required by
California state law.
Best regards,
Fr. Steve Tumbas, Camp Director
CAMP SAINT SAVA
604 Mission Blvd., Jackson, CA 95642
of the Serbian Orthodox Church
STAFF/COUSELOR APPLICATION (1 of 2)
Please Print ClearlyDate of Application:
Name:
Address:
Last
First
City
State
Middle Initial
Number/Street
Zip
Email address for confirmation:
Education Male
Female
Age:
Date of Birth (m/d/y):
High School:
College/University:
Years Completed:
Major:
Degree:
Camp Experience
Have you ever attended Camp St. Sava?
If yes, number of years as a camper:
Have you had any other camp experience?
If yes, please describe:
Yes No
years as a counselor: Yes No
Other Information
Are you certified in CPR/First Aid?
Do you have a life guard certificate?
Have you ever held any leadership positions? If yes, please describe:
Have you had other experience
working with children? If yes, please describe:
Yes
Yes
Yes
No
No
No
Yes
No
years on staff:
CAMP SAINT SAVA
604 Mission Blvd., Jackson, CA 95642
of the Serbian Orthodox Church
STAFF/COUSELOR APPLICATION (2 of 2)
Emergency Contact: Last
First
City
State
Middle Initial
Number/Street
Emergency Contact Telephone Number:
Zip
First number to call in case of emergency
Parish Name/Location:
Is the applicant baptized in the Orthodox faith? Yes
No
PARISH PRIEST’S RECOMMENDATION
Your parish priest MUST sign this portion of the application.
With my signature, I certify that the above listed applicant fulfills all the moral and spiritual qualifications required to be a Camp St. Sava Staff Member or Counselor.
Priest’s Signature:
Parish:
APPLICANT’S SIGNATURE
Please sign and return this application with your health form and insurance information.
I understand that Camp Saint Sava is sponsored by the Serbian Orthodox Church and conducted in accordance
with the teachings of the Christ’s Church. I pledge to honor and abide by these teachings.
Applicant’s Signature:
MAKE SELECTIONS BELOW
Date:
OFFICE USE ONLY
Please circle the week(s) you are applying for:
Week 1
Circle T-shirt size:
Week 2
S
M
L
Application Form (both pages)
Week 3
XL
XXL
XXXL
Please circle the position you are applying for:
Counselor
Kitchen Manager
Kitchen Helper
Dining Room Help
Life Guard
Arts/Crafts Coordinator
Night Monitor
Nurse/Physician
Evening Activities Coordinator
Other
Health Form
Insurance Form
Consent/Release Form
Camp Policies
CAMP SAINT SAVA
604 Mission Blvd., Jackson, CA 95642
of the Serbian Orthodox Church
HEALTH FORM
for Campers, Counselors, Staff and Clergy
Name:
Parent/Spouse:
Last
First
Middle Initial
Last
First
Middle Initial
Middle Initial
Home Phone:
Work Phone:
In Case of emergency when parents/spouse is/are not available, please call:
Contact Name:
Phone:
Last
First
Relationship:
To be completed by Physician’s Office Only (signature required)
Date of most recent examination (must be within the last two years):
Physician’s Name:
Address:
Last
First
City
State
Signature
Number/Street
Phone Number:
Zip
Fax Number:
Health Care Recommendations and Restrictions by Licensed Physician
Current Treatments:
(include current medications)
Explanation of any reported
loss of consciousness,
convulsion, or concussion:
Any treatment to be continued at camp, any medication to be administered at camp
(specific dosages), any medically prescribed meal plan or dietary restrictions, any allergies
(food, drugs, plants, insects, etc.), and/or any activities to be encouraged or limited:
Date of last immunizations/tetanus shots:
Form Completed by: Date:
604 Mission Blvd., Jackson, CA 95642
CAMP SAINT SAVA
of the Serbian Orthodox Church
INSURANCE FORM
for Campers, Counselors, Staff and Clergy
INSURANCE COVERAGE INFORMATION
Name:
Parent/Spouse:
Last
First
Middle Initial
Last
First
Middle Initial
Middle Initial
Home Phone:
Work Phone:
In Case of emergency when parents/spouse is/are not available, please call:
Contact Name:
Last
Phone:
First
Relationship:
MEDICAL INSURANCE INFORMATION
Insurance Company:
Contact Number:
Group Name/Employer:
Policy Number:
Employee ID/Soc. Sec. Number:
Name of Policy Holder/Employee:
Patient’s Soc. Sec. Number:
Coverage is for:
Medical
Parent/Guardian Signature:
Hospitalization
Dental
Date:
604 Mission Blvd., Jackson, CA 95642
CAMP SAINT SAVA
of the Serbian Orthodox Church
CONSENT AGREEMENTS/RELEASE FORM
For Counselors and Staff
Name:
Last
First
Middle Initial
Consent for Field Trip
It is expressly understood and agreed that the COUNSELOR OR STAFF MEMBER assume all risks of harm,
injury or loss which he or she may incur during the time of a field trip, and that as a result, I/we, the undersigned, expressly waive and release St. Sava Camp, Jackson, CA from any and all such claims and liability. It is
also understood and agreed to that the COUNSELOR OR STAFF MEMBER shall obey all the rules of the
camp he/she is attending, including the recommendations and suggestions of the staff and chaperones.
I/we have read, understand and accept all of the above conditions.
Counselor/StaffMember Signature:
(if under the age of 21)
Parent/Guardian Signature:
Date:
Date:
Consent for Emergency Treatment
If I become ill or injured while I am at camp or on a field trip, I ask that the camp staff make reasonable attempts
to contact my emergency contact at the numbers I have provided. If you can not reach them, I/we give permission for one of the following: the delivery of treatment as directed by a licensed physician; or, my transfer to a
hospital or emergency unit if it is deemed necessary by a doctor or the camp staff. I/we will be totally responsible for all expenses, deductibles and costs related to the care and treatment.
Counselor/StaffMember Signature:
(if under the age of 21)
Parent/Guardian Signature:
Date:
Date:
Address for all Registration Forms:
Camp Saint Sava Registration
PO BOX 965
Jackson, CA 95642
Voicemail: (209) 223-1437
(DO NOT SEND ANY MAIL TO 604 MISSION BLVD.)
Need more forms? Please visit www.campstsava.org
604 Mission Blvd., Jackson, CA 95642
CAMP SAINT SAVA
of the Serbian Orthodox Church
CAMP POLICIES (1 OF 2)
For Counselors and Staff
Note: This form must be signed by each counselor,
parent/guardian (if applicable), staff applicant and his/her parish priest.
GOALS
We seek to create a safe, healthy environment where all campers, staff and counselors:
1. Share fellowship and Serbian Orthodox Christian services and culture,
2. Adhere to a code of mutual respect, honor and honesty,
3. Behave courteously toward all clergy, staff and each other,
4. Respond to staff directives, and participate fully in all camp activities,
5. Respect each other’s property and that of the camp.
DISCIPLINARY PROCEDURES AND LEVELS
Discipline in our Orthodox church camp is an aspect of moral guidance and refers to
those reasonable controls which promote individual development and self-discipline
where the rights and responsibilities of all campers and staff are recognized and upheld.
Those campers, counselors and staff who work against the goals listed above will be
subject to the following levels of disciplinary measures:
1st offense: conference with lay director;
2nd offense: assignment of special tasks and/or denial of privileges;
3rd offense: conference with lay director and clergy and potential expulsion from camp.
Further, any defacement of, or damage to camp property (including but not limited
to writing or inscribing on dorm wall, closets, beds, dressers, bathroom walls, etc) will
result in both disciplinary action and financial consequences. All campers, counselors,
and staff will be held financially liable for the repair of any damage for which they are
responsible.
604 Mission Blvd., Jackson, CA 95642
CAMP SAINT SAVA
of the Serbian Orthodox Church
CAMP POLICIES (2 OF 2)
For Counselors and Staff
Note: This form must be signed by each counselor,
parent/guardian (if applicable), staff applicant and his/her parish priest.
ZERO TOLERANCE OFFENSES FOR COUNSELORS & STAFF:
LEADING TO IMMEDIATE DISCIPLINE OR EXPULSION FROM CAMP
THESE INCLUDE, BUT ARE NOT LIMITED TO:
1. Disruptive behavior, i.e. “raiding dorms,” bullying and hazing other campers.
2. Leaving the dormitory after lights out.
3. Theft, extortion or arson.
4. Assault, battery, inappropriate physical contact or any threat of violence.
5. Possession of fire arms or other lethal weapons.
6. Malicious damage or destruction of real or personal property at camp.
7. Use, sale, distribution or possession of tobacco, alcohol or controlled substances,
especially to minors.
8. Becoming inebriated or intoxicated from the use of alcohol or controlled substances.
Note: At the sole discretion of the weekly clergy director and/or lay director, adult staff may be permitted
to smoke or consume some alcohol. At no time is this privilege to be extended to under age campers.
Reminder: In California, the legal age to purchase and smoke cigarettes in public is 18 years and the legal
age to purchase and consume alcoholic beverages is 21 years.
I/We have read and understood the camp policies (pages 1 & 2) and the potential consequences of violating those rules and policies.
Signature of Counselor/Staff: _______________________________________
Signature of Parent/Guardian: _____________________________________
(if applicant is under age 21)
Signature of Parish Priest: _________________________________________
Print Name of Parish Priest: _________________________________________
Priest to initial to verify that applicant is a baptized Orthodox Christian
Yes ____ No ____
604 Mission Blvd., Jackson, CA 95642
CAMP SAINT SAVA
of the Serbian Orthodox Church
Camp St. Sava -- St.INVESTIGATION
Sava Mission of the Serbian
Orthodox Church
BACKGROUND
AUTHORIZATION
Required of All Camp Counselors and Staff in Constant Contact with Children
DISCLOSURE AND AUTHORIZATION
[IMPORTANT -- PLEASE READ CAREFULLY BEFORE SIGNING AUTHORIZATION]
DISCLOSURE REGARDING BACKGROUND INVESTIGATION
Camp St. Sava/St. Sava Mission (“the Company”) may obtain information about you for employment purposes from a
third party consumer reporting agency. Thus, you may be the subject of a “consumer report” and/or an “investigative
consumer report”. These reports may contain information regarding your credit history, criminal history, social security
verification, motor vehicle records (“driving records”), verification of your education or employment history, or other
background checks. Credit history will only be requested where such information is related to the duties and
responsibilities of the position for which you are applying. You have the right, upon written request made within a
reasonable time after receipt of this notice, to request disclosure of the nature and scope of any investigative consumer
report. Please be advised that the nature and scope of the most common form of investigative consumer report obtained
with regard to applicants for employment is ONLY an investigation into your criminal history and social security verification
conducted by First Advantage, 1 Concourse Parkway NE, Suite 200, Atlanta, GA 30328 Tel: 866-400-3238. The scope of
this notice and authorization is all-encompassing, however, allowing the Company to obtain from any outside organization
all manner of consumer reports and investigative consumer reports now and throughout the course of your employment to
the extent permitted by law. As a result, you should carefully consider whether to exercise your right to request disclosure
of the nature and scope of any investigative consumer report.
ACKNOWLEDGMENT AND AUTHORIZATION
I acknowledge receipt of the DISCLOSURE REGARDING BACKGROUND INVESTIGATION and A SUMMARY OF YOUR
RIGHTS UNDER THE FAIR CREDIT REPORTING ACT and certify that I have read and understand both of those
documents. I hereby authorize the obtaining of “consumer reports” and/or “investigative consumer reports” by the
Company at any time after receipt of this authorization and throughout my employment, if applicable. To this end, I hereby
authorize, without reservation, any law enforcement agency, administrator, state or federal agency, institution, school or
university (public or private), information service bureau, employer, or insurance company to furnish any and all
background information requested by First Advantage, 1 Concourse Parkway NE, Suite 200, Atlanta, GA 30328 Tel:
866-400-3238, another outside organization acting on behalf of the Company, and/or the Company itself. I agree that a
facsimile (“fax”), electronic or photographic copy of this Authorization shall be as valid as the original.
California applicants or employees only: By signing below, you also acknowledge receipt of the NOTICE REGARDING
BACKGROUND INVESTIGATION PURSUANT TO CALIFORNIA LAW. Please check this box if you would like to receive
a copy of an investigative consumer report or consumer credit report at no charge if one is obtained by the Company
whenever you have a right to receive such a copy under California law. □
Last Name ________________________________ First Name __________________________ Middle __________
Street Address________________________________City______________________State_____Zip_________________
Social Security Number:________-______-_________ ALL FIELDS ARE REQUIRED FOR INVESTIGATION
Signature _________________________________ Date ________________________________
604 Mission Blvd., Jackson, CA 95642
CAMP SAINT SAVA
of the Serbian Orthodox Church
APPLICATION CHECKLIST
For Counselors and Staff
Application Form (online)
Please print and mail all of the following completed documents:
Health Form
Insurance Form
Consent/Release Form
Camp Policies
Background Authorization
Address for all Registration Forms:
Camp Saint Sava Registration
PO BOX 965
Jackson, CA 95642
Voicemail: (209) 223-1437
Need more forms? Please visit www.campstsava.org