Summer Camp Staff
Volunteer Application
Name: _______________________________________
Camp Yavapines
Summer 2015
Our goals are to:
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Connect each camper with Jesus.
Ignite their active love for Him.
Forge them into spiritual leaders who will
share the Good News of Jesus.
Staff Qualifications:
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Have a daily growing relationship with Jesus Christ.
Be able to communicate Christ as a personal Savior and loving friend to both
campers and staff.
Have a positive attitude with an ability to fulfill responsibilities.
Work as a team player.
Be kid-focused and have a desire to see them accept Jesus as their Savior.
Be in good health and vitality.
Be able to take directions and implement advice.
Be FLEXIBLE!
Arizona Conference of Seventh-day Adventists
Camp Yavapines
2999 W. Iron Springs Road - Prescott, AZ 86305
Phone: 928-445-2162 Fax #928-445-8043
Email: [email protected]
FOR OFFICE USE ONLY
Applicant Name ___________________________
Date Application Received _____/_____/________
Type Position _____________________________
Date Interviewed __________________________
PERSONAL
Name _________________________________________________ Age ________ Soc. Sec. # ___________________
Home Address ____________________________________________________________________________________
School Dorm Address _______________________________________________________________________________
Phone ___________________________________________ Mobile _________________________________________
T-shirt size (circle) S
M
L
X
XXL
Marital Status: Single ___ Married ____ Divorced ____
Current occupation or work __________________________________________________________________________
Supervisors _______________________________________________________________________________________
School offices and responsibilities held _________________________________________________________________
School you will attend next year ________________________________________ Grade next year ________________
Are you SDA? Yes ____ No ___ Home Church ______________________________ Pastor _______________________
What commitments do you have for next summer? (engagement, marriage, wedding, vacations, family plans, etc.)
_________________________________________________________________________________________________
CAMP EXPERIENCE
For which staff position are you applying? (Please list in priority)
1. ______________________________________
2. ______________________________________
3. ______________________________________
What are your qualifications for these positions?
1. _____________________________________________________________________________________________
2. _____________________________________________________________________________________________
3. _____________________________________________________________________________________________
Have you ever been a camper? _________ If yes, where? _________________________________________________
Please list any paid camp staff experience:
Where: ___________________________ Position: ____________ Year: _________ Camp Director: ______________
Where: ___________________________ Position: ____________ Year: _________ Camp Director: ______________
Where: ___________________________ Position: ____________ Year: _________ Camp Director: ______________
HEALTH
Your present health:
Excellent ___
Good___
Fair
___
Poor___
Last injury or surgery: _______________________________________________________________________________
List any allergies: ___________________________________________________________________________
Do you have any physical handicaps? _________________________________________________________________
Who should be contacted in case of emergency? ________________________________________________________
Name: _____________________ Relationship:________________ Phone: ______-______-_______________
SKILLS AND INTERESTS
Arts and Crafts
Circle (1 for interest, 2 for knowledge, 3 for skill)
Waterfront
Miscellaneous
Ceramics
1
2
3
Canoeing
1
2
3
Braiding
1
2
3
Swimming
1
2
3
Indian Lore
1
2
3
Springboard Diving
1
2
3
Leather Craft
1
2
3
W.S.I.
1
2
3
Pottery
1
2
3
Sculpturing
1
2
3
Soap Craft
1
2
3
Weaving
1
2
3
Safety
Basic Rescue
1
2
3
CPR
1
2
3
First Aid
1
2
3
Certified Life Guard
1
2
3
Music
Camp Songs
1
2
3
Song Leading
1
2
3
Special Music
1
2
3
Instruments
__________
1
2
3
Other skills and interests we should know about:
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
Programming
Devotional Talks
1
2
3
Group Games
1
2
3
Skits/Plays
1
2
3
Puppets
1
2
3
Archery
1
2
3
Mountain Biking
1
2
3
Horsemanship
1
2
3
Go Kart/Auto
Mechanics
1
2
3
Gymnastics
1
2
3
Camping Skills
Rock Climbing/
Rappelling
1
2
3
Camp Cookery
1
2
3
Fire Building
1
2
3
Zip Line
1
2
3
Hiking
1
2
3
Mountain
Boarding
1
2
3
Knots
1
2
3
Orienteering
1
2
3
Disc Golf
1
2
3
Tent Camping
1
2
3
Other
_____________
1
2
3
Other
_____________
1
2
3
SPIRITUAL SELF-EVALUATION
Excellent
Above Average
Average
Below Average
Regularly
Occasionally
Rarely
Not a Practice
I perceive my spiritual condition as
My teachers perceives my spiritual condition as
My best friends perceive my spiritual condition as:
My spiritual involvement is:
Please give examples: ______________________________
_________________________________________________
CHRISTIAN BEHAVIOR
I have prayer and devotions
I am involved in outreach activities *
I attend Sabbath School and Church
My use of tobacco or alcohol is:
* Please specify or add your comments: ________________________________________________________________
UNLAWFUL CONDUCT
Have you been (formally or informally) accused, charged or disciplined for any unlawful sexual conduct, child abuse,
and/or child sexual abuse? Yes ___
No___
Have you been (formally or informally) accused, charged or disciplined for use of any illegal drugs?
Yes___
No___
Signed ______________________________________ Date _____________________
PATHFINDER INVOLVEMENT
Were you a Pathfinder? Yes___
No___
What is the highest Pathfinder class completed? __________________
List as many Pathfinder Honors earned as you can remember (use backside if necessary) _________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Any outstanding Pathfinder experiences? _______________________________________________________________
_________________________________________________________________________________________________
Complete each statement:
“I want to work for Camp Yavapines because… ___________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
“I believe the aim and purpose of a summer camp should be … _____________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
How and why did you become a Christian? ______________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
What makes your lifestyle as a Christian unique? _________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
How do you personally maintain a daily relationship with Jesus? ____________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
RECOMMENDATIONS
Please list the individuals who will be sending in your recommendation forms (not a relative):
1. Name: ________________________________________________ Phone: ________________________
Address: _______________________________________________ Position: _______________________
2. Name: _________________________________________________Phone: ________________________
Address: _______________________________________________ Position: _______________________
3. Name: _________________________________________________Phone: ________________________
Address: _______________________________________________ Position: _______________________
Optional Information: Date of Birth _____________________________
Thank you for your candid responses.
This information is confidential, and is intended to be reviewed only by the hiring personnel.
Yavapines Staff Emergency Form
Name:____________________________________
Age:_______ Gender:__________
Birth Date:________________
City:_______________ State:_______ Zip:_________
Home Phone: ___________________
Mobile Phone: __________________
Emergency Contact Information
1. Name:______________________________
Relationship: ________________________
Home Phone: ________________________
Mobile Phone: _______________________
2. Name: _____________________________
Relationship: ________________________
Home Phone: ________________________
Mobile Phone: _______________________
Insurance Information
Primary Insurance Carrier: _______________________
Policy Holder’s Name: __________________________
Policy Number: ________________________________
Group Number: ________________________________
Allergies (medication, food, animals, etc.) and reaction:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Current Prescription Medications:
___________________________________________________________________________
___________________________________________________________________________
Medical Conditions (Anemia, High Blood Pressure, Hearing Loss, Asthma, Diabetes, etc.)
___________________________________________________________________________
___________________________________________________________________________
Signature___________________________________________Date__________________