Camp Surrey Staff Registration – Grace Communion Surrey Hills

All staff members must be at least 13 years old at the time of camp. Will you be at least 13 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.

What age group will you be in on June 1st, 2025? *

13 - 17
18+

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 *

Please list your top three staff positions in order of preference.

Positions include: Table leader (Mini Camp or Junior Camp), Table assistant (Mini Camp or Junior Camp), Activities Staff (includes Kayaking Staff, Climbing Wall Staff, Arts and Crafts Staff, GaGa Ball/9 square staff, Obstacle Course/Outdoor activity Staff, General Activity Staff), Kitchen Staff, Media Team, Nurse Team, Safety Team, Mini Camp Support Staff (to give breaks to/support mini camp team leaders). If you are a teen volunteer your options to serve may be more limited but we will do our best to accommodate one of your choices.

Many staff positions require staff to be present through the duration of Camp. This includes Wednesday, Thursday, and Friday from 8:00am to 5:30pm, and Saturday from 10:00am to 3:00pm. 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

Church/Ministries Information

Are you a member of a Grace Communion International congregation? If so, which congregation?

Date of Baptism, if applicable.

How long have you attended church within Grace Communion International?

Please list any other ministries in which you have served within a Grace Communion International congregation, camp or other ministry:

Please check the areas/groups you regularly attend:

Experience

Please provide a brief history of your experience working with youth programs of Grace Communion Surrey Hills, Grace Communion International, loval schools and other organizations.

Type of Experience

Start Date//

Program Director’s Name *

First

Last

Name of Organization

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Type of Experience

Start Date//

Program Director’s Name *

First

Last

Name of Organization

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Type of Experience

Start Date//

Program Director’s Name *

First

Last

Name of Organization

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Character Traits and Abilities

What character traits and abilities do you have that qualify you to work with youth in learning situations and athletic programs? Please list. *

What character traits, if any, do you feel will limit your effectiveness in working with the youth ministry programs? Please list. *

Have you had any painful experiences in your life that have better equipped you for, or may hinder your from, a productive ministry with youth? *

Would you like to meet with a pastor regarding this circumstance?

Have you ever been hospitalized or treated for alcohol or substance abuse? *

Are there any circumstances involving your life-style or your background that would call into question your ability to work with youth? *

Do you ever abuse alcohol? *

Have you ever used illegal drugs? *

Are you currently using illegal drugs? *

If you answered yes to any of the above questions, please explain:

Civil Records (lawsuits)

Have you ever been convicted of any crimes? *

Penalties Imposed

Have you ever had a civil judgment entered against you or is there a pending complaint against you? *

Case Number(s)

What was the judgement entered against you?

Any other terms of judgement against you?

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 notwithstanding 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

Staff Personal References

It is our desire to provide the absolute best experience and safe environment for the participants at Camp Surrey. Part of our process to ensure this desire is to select staff to serve at camp who exemplify great character and a heart to serve. In being a part of our volunteer staff team, it is imperative that our staff have characteristics of a servant, team-based, being able to work in fast-paced environments, and being willing to do a variety of tasks that may or may not be in any particular job description with a great attitude. It's this kind of mentality that promotes the culture at camp. In helping us to get to know you better, all volunteer staff applicant ages 18 and above must provide 2 references of individuals who know you personally, your character, and work ethic that Camp Surrey/Grace Communion Surrey Hills leadership may contact. References MUST NOT be related to you. Please feel free to use a member of the local church as a reference!

Reference #1

Reference #1 Name *

First

Last

Reference #1 Relationship to candidate *

Reference #1 Email *

Reference #1 Phone *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Reference #1 Questions or Comments

Reference #2

Reference #2 Name

First

Last

Reference #2 Email *

Reference #2 Relationship to candidate *

Reference #2 Phone *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Reference #2 Questions or Comments

Reference #3 Name *

First

Last

Reference #3 relationship to candidate *

Email *

Refrence #3 Phone *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Reference #3 Comments or Questions

Name of Present Employer

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Name of Immediate Supervisor

First

Last

Phone

Length of Time Employed

Staff Background Check

In addition to giving 2 personal references, ALL staff members ages 18 and over MUST have on file with Grace Communion Surrey Hills (GC Surrey Hills) a current and cleared background check that is initiated by GC Surrey Hills. Once you have completed the Camp Surrey Staff Registration application, a member of Camp Surrey/GC Surrey Hills will be in contact with you to initiate the background check. *All background checks are kept confidential and inaccessible by any person not part of the Pastoral Team.

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 *

Today's Date *