CARLTON HILLS MAKE A JOYFUL NOISE
ART AND MUSIC SUMMER CAMP
2015 Employment Application– Application due May 15, 2015
Camp dates: July 6th to 31st. Training is mandatory (see dates below) Staff report time is 8:30
a.m. until 3:30 p.m. Monday through Friday from July 6th to July 31st.
APPLICANT INFORMATION
Last Name
First
M.I.
Street Address
Date
Apartment/Unit #
City
State
Cell
Phone
Date of
Birth
ZIP
E-mail Address
Social Security
Number
Are you a citizen of the United States?
YES
NO
If no, are you authorized to work in the U.S.?
Have you worked at this camp before?
YES
NO
If so, please
list years
Have you ever been convicted of a felony?
YES
NO
If yes, explain
EDUCATION
High School
From
Grade
To
Did you graduate?
College
From
YES
NO
Degree
NO
Degree
Major
To
Did you graduate?
YES
REFERENCES
Please list two references (other than past staff or adults who work camp) who can verify your work with children
Full Name
Phone
(
)
Full Name
Phone
(
)
PREVIOUS CAMP HISTORY
Camps
attended
Dates
Camps worked
Dates
Responsibilities
Camps worked
Dates
Responsibilities
PREVIOUS EMPLOYMENT/VOLUNTEER EXPERIENCE
Company
Dates
Carlton Hills Evangelical Lutheran Church, 9735 Halberns Blvd., Santee, CA 92071
Phone: 619-448-1888
www.carltonhillslutheran.org
YES
NO
Responsibilities
Company
Dates
Responsibilities
EMERGENCY CONTACT INFORMATION
Last
Name
First
Relationship to
you:
Street Address
City
State
Home
Phone
Cell
Phone
ZIP
Work Phone
E-mail Address
Last
Name
First
Relationship to
you:
Street Address
City
State
Home
Phone
Cell
Phone
ZIP
Work Phone
E-mail Address
POSITIONS YOU ARE WILLING TO WORK – CHECK ALL THAT APPLY
Rotation Leader: ____ Assistant Rotation Leader: ____ Describe Rotation____________________________
Counselor: ____ Assistant Counselor:____ Worship Leader:____________ Rec leader :___________
Private Music Lessons: ____ What area would you give lessons – (lessons are $10 per half hour)? ____
Before/After Care____ What gifts and/talents you can offer the camp:
DISCLAIMER AND SIGNATURE
I certify that my answers are true and complete to the best of my knowledge. I understand that
as a part of my employment I must be CPR and First Aid certified and present the camp with a
current card. I also understand I must attend the following trainings:
Members of Carlton Hills are required to attend One Salvation Tuesday Nights
7:00 p.m. to 8:00 p.m.
Training: June 30, July 1, July 2 9:30 to 3:30
Questions? Call Selina: (619) 277-5851 or Belinda: (619) 368-9651
Signature
Date
Due ASAP for priority consideration – applications will be taken until positions are filled.
You are strongly encouraged to keep a copy of your application for yourself! Interviews to follow-make sure to schedule with Selina
or Belinda.
Signature:
_________________________________
Date: _________________
Carlton Hills Evangelical Lutheran Church, 9735 Halberns Blvd., Santee, CA 92071
Phone: 619-448-1888
www.carltonhillslutheran.org
Make A Joyful Noise Summer Art and Music Camp Application
Release Agreement for staff members under age 18
Staff name participating in the Make a Joyful Noise Summer Art and Music Camp ____________________
In order to reduce the risk of liability and to keep the cost of the operations of the activity as reasonable as possible we are asking our
participants to read and sign the following provisions. If you have any questions please feel free to inquire and we will do our best to
explain.
In consideration of the use of the property, facilities and/or services of Carlton Hills Evangelical Lutheran Church, including any travel related
thereto, the undersigned agrees as follows:
1.
RISK FACTORS. The undersigned understands and acknowledges that participation in the Summer Music & Arts Camp
activities involves risks such as but not limited to that which might result from the activity itself, the acts of others or the unavailability
of emergency medical
care; RISK OF PROPERTY DAMAGE, BODILY INJURY, and POSSIBLY DEATH.
2.
ASSUMPTION OF RISK. The undersigned ASSUMES ALL RISKS WHICH ARE FORESEEABLE AND INVOLVED WITH OR
ARISING FROM PARTICIPATION AT THE SUMMER CAMP, including without limitation those risks described in Section 1 above.
3.
SKILLS AND TRAINING. The undersigned acknowledges that the minor child listed above has the physical and emotional ability
necessary
to participate. The undersigned agrees that if he or she has any questions as to what qualifications are necessary to properly
participate in the summer camp activities, then they shall direct such questions to the office personnel.
4.
RELEASE. The undersigned RELEASES Carlton Hills Evangelical Lutheran Church, the Evangelical Lutheran Church of America
and all of
their officers, employees and agents (referred to below as the "RELEASED PARTIES") and agrees NOT TO SUE them
on account of or in
connection with any claims, causes of action, injuries, damages, cost or expenses (referred to below as the
"CLAIMS") arising out of participation in the Camp activities, including those based on the risks described in Section 1, whether or
not caused by the negligence or other
fault of the RELEASED PARTIES.
5.
WAIVER. The undersigned waives the protection provided by any statute or law in any jurisdiction including California Code
section 1542
whose purpose, substances and/or effect is to provide that a general release shall not extend to claims, material or
otherwise which the persons
giving the release does not know or suspect to exist at the time of executing the release. This
means, in part, that the undersigned is releasing
unknown future claims.
6.
INDEMNIFY AND DEFEND. The undersigned agrees to INDEMNIFY AND DEFEND the RELEASED PARTIES against, and hold
them
harmless from, any and all CLAIMS, including attorney fees, which in any way arise from the activity which is the subject of
this agreement and which include but are not limited to those risks described in Section 1 including any liability arising from the act
or negligent act of the
RELEASED PARTIES, the undersigned or anyone else.
7.
PAY. The undersigned agrees to pay for any and all damages to any property of the RELEASED PARTIES caused by the
undersigned whether
negligently, willfully or otherwise.
8.
LEGAL FEES. In the event of any controversy, claim or dispute between the parties arising out of or relating to this
agreement or the breach hereof or the activity, the prevailing party shall be entitled to recover from the losing party reasonable
expenses, attorney fees and costs.
9.
REPRESENTATIVES. The undersigned enters into this agreement for himself/herself, heirs, assigns and legal
representatives.
10.
ACKNOWLEDGEMENT. The undersigned has read and understands this agreement and realizes it relates to releasing
valuable legal rights and does so freely and voluntarily.
APPROVAL OF PARENT/LEGAL GUARDIAN ON BEHALF OF MINOR
I am the parent and/or legal guardian of the above-named minor. I have read and understand the agreement and realize the
agreement involves
releasing valuable legal rights for the minor and myself. I agree to be bound by all of the terms of the
agreement. I also give my consent to the
participation in the summer camp by the minor.
Signature of parent/legal guardian Carlton Hills Evangelical Lutheran Church, 9735 Halberns Blvd., Santee, CA 92071
Phone: 619-448-1888
www.carltonhillslutheran.org
Date Please photo copy the front and back of the youth’s insurance card and staple it to this
page (or scan).
RELEASE INFORMATION:
Please Initial:
YES –I give permission for my child’s picture and/or name to be used in printed advertisements or on
the Carlton Hills Evangelical Lutheran Church website.
YES – I give permission for my child’s picture and/or name to be used in developing media as a part of
the camp one year we developed a malaria video – you can view it at: http://www.youtube.com/watch?v=xNazChhZ6UA
YES – I grant permission for my child to attend camp activities.
YES – I grant permission for my child to attend camp field trips.
Staff is required to bring their lunch each day. Camp is a No Nut Zone, as we have children that are deathly allergic to
peanuts or anything made with nuts.
The purpose of camp is to learn about God while having fun in a safe environment. If your child experiences a behavior
challenge, you will be contacted by Pastor Rick, Selina Weber, or Belinda Karge. If the situation continues, a behavior
contract will be written and may include dismissal from camp if behavior is not changed.
Print parent name
___________________________________________
Parent signature and date:
If staff is over 18 they can sign for
themselves
Carlton Hills Evangelical Lutheran Church, 9735 Halberns Blvd., Santee, CA 92071
Phone: 619-448-1888
www.carltonhillslutheran.org