Camp Counselor Application

Personal Data

First Name

Last Name

Phone

Birth Date

Age

Your photo

Choose File

Highest Level of Schooling Completed

Address

City

State

Zip Code

Parents

First Name

Last Name

Parent's Phone

Parent's Email

Is their address different that yours?

Yes

Address

City

State

Zip Code

Attitude of your parents/spouse towards your involvement in camp.

Acquaintance

First Name

Last Name

Acquaintance Phone

Acquaintance Email

Acquaintance Address

Address

City

State

Zip Code

Pastor

Pastor's First Name

Pastor's Last Name

Pastor"s Phone

Pastor's Email

Church

Church Affiliation

Have You Been Baptized?

Are You a Church Member?

Church Address

Address

City

State

Zip Code

Please describe your personal testimony as to how you became a Christian and include some things that the Lord has done in your heart and life since your conversion.

Medical Information

Do you have any physical weakness, allergy, disability, or recurring medical problems? If so, explain.

Have you suffered from any serious illness or accident? If so, explain.

Have you ever been treated for any mental or emotional condition? *

Person we could contact in case of an emergency.

Emergency Contact Phone

In the event of an accident or illness requiring, special drugs, therapy treatment, services of a hospital,
physician, dentist, ambulance or any other related expense, the charges will be made to the applicant and the signee hereby agrees to pay for all services that may be required; and Keystone Arrows/Rubies
Camps, its Directors, staff members and facilities on or outside the camp property are hereby released
from any and all liabilities

Record

Have you ever been convicted of child abuse or a crime involving actual or attempted sexual molestation of a minor?

Please Explain Below

Have you ever been arrested or charged with a criminal offense other than traffic violations?

Please Explain Below

(The extra day and a half will be given to extended orientation, team concepts, personal spiritual development, and camp operation) If there is a conflict of schedule, please inform us of the details. Thanks.