GARDENDALE RFKC 2016 - RETURNING COUNSELOR AND STAFF APPLICATION

GARDENDALE ROYAL FAMILY KIDS' CAMP 2016 - RETURNING COUNSELOR/STAFF APPLICATION
PERSONAL INFORMATION
DATE:

MonthDayYear
FULL NAME:

First NameLast Name
GENDER:
DATE OF BIRTH:

MonthDayYear
AGE:
PERSONAL ADDRESS:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
MARITAL STATUS:
OCCUPATION:
NUMBER OF YEARS IN OCCUPATION:
PRIMARY PERSONAL PHONE NUMBER:

Area CodePhone Number
WORK PHONE NUMBER:

Area CodePhone Number
PERSONAL E-MAIL ADDRESS CHECKED REGULARLY:
EMERGENCY CONTACT:
EMERGENCY CONTACT'S PHONE NUMBER:

Area CodePhone Number
T-SHIRT SIZE:
Check any of these for which you are certified:

CPRFIRST AIDLIFE GUARDNURSEEMTOther
Have you worked with or associated with abused, neglected, or abandoned children this past year?

YesNo
If you answered "yes," in what way?
Please describe why you wish to return as a counselor or staff member for abused and neglected kids.
MEDICAL HISTORY
Have you had any medical problems?

YesNo
If you answered "yes," please describe:
Do you take any medications?

YesNo
If you are taking medications, please list them and any side effects.
Have you had any serious injuries or illnesses since the last camp?

YesNo
If you answered "yes," please explain.
PERSONAL GROWTH
If you were abused, neglected or abandoned as a child, how did that affect you at camp?
Please describe your spiritual growth since you have been a Royal Family Kids’ Camp staff member or counselor:
How has Royal Family Kids’ Camp made an impact on your life?
From your experience, what would you suggest to a new counselor or staff member coming for the first time?
Can you name a staff member or counselor that was a great help to you? And in what way?
How has your family responded to you being involved with Royal Family?
What current ministries or activities are you involved with at your church?
What new strengths have you discovered since working with abused kids?
What new weaknesses have you discovered since working with abused kids?
For returning counselors: This year I would prefer my campers to be:

6-7 years old8-9 years old10-11 years oldNo preference
List any suggestions you feel would make the camping experience for the kids, counselors & staff even better!
Since your original application, have you been arrested for a criminal offense?

YesNo
Since your original application have you been accused of any sexual misconduct?

YesNo
Since your original application have you been convicted of any sexual misconduct?

YesNo
Since your original application have you taken drugs other than prescription drugs?

YesNo
If you answered “YES” to any of the above please explain.
By typing my name, I hereby signify the above information is true and correct to the best of my knowledge.
Date of Signature:

MonthDayYear
Should be Empty:

GARDENDALE ROYAL FAMILY KIDS' CAMP 2016 - RETURNING COUNSELOR/STAFF APPLICATION