Camp Surrey Xtreme Staff Registration – Grace Communion Surrey Hills

All staff members must be at least 18 years old at the time of camp. Will you be at least 18 years old at the time of camp? *

Yes

Staff First Name *

Staff Last Name *

Do you go by a different name? If yes, please let us know.

Have you completed Ministry Safe requirements with GC Surrey Hills? *

Yes
No

Gender

Email *

Email

Confirm Email

Phone *

Can you receive text messages? *

Yes
No

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Shirt Size *

Many staff positions require staff to be present through the duration of Camp. This includes Thursday from 7pm-10pm, and Friday and Saturday from 2pm - 10pm. Please select all days you will be available so we can find the best staff position for you! *

Comments

Do you have specialized training? (i.e. current CPR, First Aid, Lifeguard, Counselor, etc.) *

Yes
No

Have you been to Camp Surrey before? *

Yes
No

Civil Records (lawsuits)

Job Functions

The essential job functions of a youth worker may include the ability to perform strenuous physical labor and may require skills in competitive sports, which demand endurance and dexterity. Are you capable of performing those functions? *

If reasonable accommodation is needed, how would you perform those tasks and with what accommodation(s)?

What prompted you to consider volunteering? *

Staff Medical Release & Permission

As a staff candidate, by my dated initials and signature below, I certify the statements and information provided in items 1 through 6 that appear below:

1. ACCEPTANCE OF CAMP CONDITIONS: I understand and agree to the condition of the event venue as described in the information provided at GCSURREYHILLS.ORG/CampSurrey. I agree to participate under these conditions, including Photo/Video Release, Camp Surrey Standards Agreement, schedule of activities, and material to be presented.

2. DISCLOSURE OF SPECIAL HEALTH CONDITIONS: The following is the list of my special health conditions and needs, which event staff needs to be aware of:

Do you have any known special health conditions and/or allergies that the Camp Surrey Staff should be aware of? *

Yes
No

Do you require any special needs/assistance? *

Yes
No

3. RELEASE OF LIABILITY REGARDING SPECIAL HEALTH CONDITIONS: I submit that the above mentioned special health conditions and instructions are needed for myself while at the event. I understand that, although event personnel will seek to help accommodate these special conditions, nonetheless, by attending the event with these special health conditions:

By initialing, I certify it is safe for myself to participate in all event activities notwithstanding the special conditions, and not withstanding any possible lapse in medication, or possible interaction with other people or circumstances that may affect the special conditions. *

I understand that the church does not provide personal medical or health insurance, and that it is my responsibility to provide personal insurance. *

4. PERMISSION TO SECURE EMERGENCY SERVICES: I give permission to event staff to secure usual and customary medical and/or legal services for myself if needed in an emergency circumstance at the event. I understand that I will be responsible for the costs of such services if not covered by my insurance.

By initialing, I understand the event is not equipped to monitor or supervise such special conditions or needs. *

Emergency Contact Information

Please enter the name of the parent or guardian who should be contacted in the case of an emergency.

Emergency Contact Name #1 *

First

Last

Emergency Contact #1 Phone *

Emergency Contact Name #2 *

First

Last

Emergency Contact #2 Phone *

Questions or Comments

Required Acknowledgement of Agreements

PLEASE NOTE: To read all agreements before initialing, go to gcsurreyhills.org/campsurrey/camper-agreements.

By initialing, you are stating that you have read and agree to the Camp Surrey Standards Agreement *

By initialing, you are stating that you have read and agree to the Camp Surrey Photo/Video Agreement *

By initialing, you are stating that you have read and agree to the Camp Surrey Medical Release/Parental Permission Form *

By initialing, you are stating that you have read and agree to the Camp Surrey Climbing Wall Release & Waver Form *

By initialing, you are stating that you have read and agree to the Camp Surrey Standards Agreement, the Chapter 4 Children and Teen Ministry Health and Safety Policies, and the Appendix 3 Event Staff Acknowledgement *

Authorizations - Please read BEFORE submitting

The information contained in this application is correct to the best of my knowledge. I, the undersigned, give my authorization to Grace Communion International or its representatives to release any and all records or information relating to working with minors. The church may contact my references and appropriate government agencies as deemed necessary to verify my suitability as a youth worker.

Volunteer Staff Applicant Signature *

Clear Signature

Today's Date *

Church/Ministries Information

Experience

Character Traits and Abilities

Civil Records (lawsuits)

Job Functions

Staff Medical Release & Permission

Emergency Contact Information

Staff Personal References

Reference #1

Reference #2

Staff Background Check

Required Acknowledgement of Agreements

Authorizations - Please read BEFORE submitting