Register

This application must be fully completed by those who wish to be volunteers or employees at Kids Kamp, Family Camp, or Youth Camp. Please submit this form by June 4th if possible. Once submitted it will be reviewed by District staff. The application follows the guidelines set up in our Districts Child Protection Policy.

It is our desire to provide a safe and secure environment for those who participate in these events. The information you give in this form will be kept on file at District Office.

I want to be a...

VOLUNTEER PAID STAFF MEMBER
Kitchen staff

I want to be at...

KIDS CAMP
July 1 - 5 		FAMILY CAMP
July 14 - 28
YOUTH CAMP
Jul 28 - Aug 2 		 

Position desired...

COUNSELOR KITCHEN WORKER
CUSTODIAL NURSERY
ADMINISTRATION

Applicant information

First Name*
Last Name*
Birth Date* 19
Marital Status*
Spouses Name*

Mailing Address

Address*
City or Town*
Province*
Postal Code*
Phone* ( ) -
Email Address*

Home Church

Church name*
Pastor*

Occupational Information

Social Insurance Number*
Occupation and Employer*

In Case of Emergency

Contact*
Phone* ( ) -

Other

Do you have children?* YES NO
If yes, is childcare arranged while at camp?* YES NO
Have you recently used tobacco or illegal drugs?* YES NO
Why do you want this ministry?*
How long have you attended your current assembly? - Are you a member?*
Where and when did you accept Christ as your personal Savior*
List all churches you have attended regularly in the last 5 years. Indicate the church name, pastor, denomination and phone number*
Please indicate any previous or present ministry involvement. List the church, supervising pastor, and the capacity in which you minister(ed)*
Have you ever been convicted of a criminal offense?* YES NO
Have you ever been convicted of a sexually related crime?* YES NO
Have ever been hospitalized or treated for alcohol or substance abuse?* YES NO
Do you have a communicable disease?* YES NO
Are you in treatment for a form of mental illness?* YES NO
Do you have any physical limitations that would prevent you from performing certain types of activities (ie.: lifting, bending etc.)?* YES NO
Please list three (3) personal references. 18 years and over, not pastors or relatives. Please indicate their full name, address and telephone number*
Please record any information about your character, conduct, personality or history that could have influence on you ability to serve at a Chrisitan Camp*

Applicants Statement

The information I have provided in this application is correct, to the best of my knowledge. I hereby authorize any references listed in this application to give any information that they may have concerning my suitability for this position. I release all such references from liability for any damage that may result in giving such evaluation.

I will attend all meetings relevant to my employment or volunteering. I will submit to each District authority.

I agree to be bound by the policies, philosophies, and directives of the Maritime District of the Pentecostal Assemblies of Canada regarding this event. I understand that law officials may access this information, under warrant, if requested.

I have read, and will adhere to, the Maritime District Child Protection Policy.

Yes, I agree.

IMPORTANT

Please do not arrive at Camp Evangeline for involvement unless you have been notified of your acceptance. You will be notified ONLY if you are accepted. Please attach an original copy of your Criminal Record Check. Mail this form to: Camp Evangeline, Box 1184, Truro, NS, B2N 5H1.