Name *
Address *
Phone *
Camp Session *
Please select the camp session(s) for which you are applying.
Are you in a healthy spiritual position to mentor young children/teens? *
Date of last tetanus shot *
Date of last tetanus shot
Family Physician Phone *
Family Physician Phone
Applicants under the age of 18 only: A parent/guardian must grant permission in case of sickness or injury. As a parent/guardian, I hereby grant permission to any physician selected by the camp to give the necessary medical treatment to this applicant.
Have you at any time been arrested for any reason, convicted of, or pleaded no contest to any crime? *
Have you at any time engaged in or been accused of any act of child molestation, exploitation, or abuse? *
Verification and Release *
Statement of Understanding *
Date of Birth
Date of Birth