Youth Camp Registration (Staff)

Staff Registration Form
Volunteer Information

Please complete each section in it's entirety. Incomplete applications WILL NOT be accepted.Is this your first year volunteering?
Legal Name / Nombre*

First Name / Primer NombreLast Name / Apellido
Female / HembraMale / Varon
Date of Birth*

MonthDayYear
Date
Age / Edad*
Marital Status
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Alternative Phone Number (Emergency Contact)
Please enter a valid phone number.
Upload a picture of yourself please/ Suba una foto de usted por favor*

Cancelof

Church Information

please fill out your church information
Please select all that apply*

Saved / SalvoBaptized in Holy Ghost / Bautizados por el Espiritu SantoSanctified / SanctificadoBaptized in water / Bautizado en aguaChurch Member / Miembro de iglesianon of these apply to me/ Ninguno aplica a mi
Name of local church you attend?/Nombre de su iglesia Local*
What is the name of your Church/Cual es el nombre de su Iglesia Local
Pastor's Name/ Nombre de Pastor*

First NameLast Name
Youth Leader's Name / Nombre de lider de jovenes*

First NameLast Name
How do you serve at church? / Como sirve en la iglesia*

Medical Information
Please answer whether or not the following may be administered to you, if needed, while at camp. You do not need to bring these since these medications are available at camp.*

Por favor indique si los siguientes medicamentos pueden administrarse, si es necesario, mientras esté en el campamento. No es necesario que los traiga, ya que estos medicamentos están disponibles en el campamento.
Acetaminophen (compared to active ingredient in Tylenol)*
Ibuprofen (compared to active ingredient in Advil)*
Diphenhydramine HCI (compared to active ingredient in Benadryl)*
Guaifenesin (compared to active ingredient in Robitussin or Mucinex)*
Bismuth Subsalicylate (compared to active ingredient in Pepto Bismol)*
Calcium Carbonate Antacid (compared to active ingredient in Tums)*
Hydrocortisone Cream 1% for itching/rash*
Allergies to any common over the counter medication? / ¿Alergias a algún otro medicamento común de venta libre?**
I hereby consent to allow camp officials to administer common over-the-counter medication. You have my permission to administer first aid and to secure medical attention for me.
Por la presente, doy mi consentimiento para que los oficiales del campamento administren medicamentos comunes de venta libre. Usted tiene mi autorización para brindar primeros auxilios y para procurar atención médica para mi*

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Allergies / Food Allergies**
Write none if question does not apply
Diagnosed Medical Condition OR Health / Behavioral Considerations*
Write none if question does not apply
Current Medication / Medicamento Actual*
Write none if question does not apply
Restrictions from Physical Activities / Restriciones fisicas*
Write none if question does not apply
Yes / SiNo
Insurance Information (Optional / Opcional)

This section is optional / esta sección es opcional. If the student has medical insurance, please provide information below. Si el estudiante tiene seguro médico, por favor proporcione la información a continuación.
Would you like to put your insurance information?
Insurance carrier
Name (As it appears on a card)
Member ID

Automobile Information / Informacion de Automobile

Please complete each section in it's entirely. Incomplete applications WILL NOT be accepted.
Do you plan on bringing a personal vehicle?
Make / Model
Color
License Plate / Licensia
Camper Agreement / Acuerdo de campista

In case of emergency please list the person authorized to pick up camper other than the parent / guardian. Only names listed below will be allowed to pick up / check out campers.

En caso de emergencia, por favor indique el nombre de la persona autorizada para recoger al participante (camper) que no sea el padre, madre o tutor legal. Solo las personas incluidas en la siguiente lista tendrán permitido recoger o retirar a los participantes.
Name

First NameLast Name
Phone Number
Please enter a valid phone number.
Relationship to staff/ Relacion al staff

Payment

payment*

Staff Ticket

$190.00 Quantity

Total

$0.00

Payment Methods

Credit Card

Apple Pay

Google Pay

Cash App Pay

ACH Bank Transfer

Should be Empty:

Rows	Yes / Si	No
1. Have you ever been charged, arrested, convicted or pled guilty to any crime? ¿Alguna vez ha sido acusado(a), arrestado(a), condenado(a) o se ha declarado culpable de algún delito?
2. Have you ever been accused, charged or alleged to have committed any act of neglecting, abusing or molesting a child or youth? ¿Alguna vez ha sido acusado(a), imputado(a) o se le ha señalado de haber cometido algún acto de negligencia, abuso o acoso contra un niño(a) o joven?
3. Have you ever been a victim of abuse (verbal, physical, sexual)? If you prefer, you may discuss the answer to the previous question with a pastor or ministry leader. ¿Alguna vez ha sido víctima de abuso (verbal, físico, sexual)? Si lo prefiere, puede hablar sobre la respuesta a la pregunta anterior con un pastor o líder ministerial.
4. Have you ever been involved in homosexual activity? ¿Alguna vez ha participado en actividad homosexual?
5. Have you ever been accused, charged or alleged to have committed a theft? ¿Alguna vez ha sido acusado(a), imputado(a) o señalado(a) de haber cometido un robo?
6. Are you addicted to prescription drugs?¿Es adicto(a) a medicamentos recetados?
7. Do you use tobacco in any form?¿Usa tabaco en cualquiera de sus formas?
8. Do you use any type of electronic cigarette or similar ¿Usa algún tipo de cigarrillo electrónico o dispositivo similar? (por ejemplo: vape, Juul, etc.)
9. Do you have problems sleeping?¿Tiene problemas para dormir?
10. Do you have recurring nightmares or sleep disturbances?¿Tiene pesadillas recurrentes o trastornos del sueño?
11. Do you have a history of use of pornographic materials? ¿Tiene antecedentes de uso de material pornográfico?
12. Have you ever been charged with moving traffic violations? ¿Alguna vez ha sido acusado(a) de infracciones de tránsito en movimiento?
13. Has your driver’s license ever been revoked or suspended? ¿Alguna le han revocado o suspendido su licencia de conducir?

Staff Registration Form

Volunteer Information

Church Information

Youth Camp Registration Position

Medical Information

Insurance Information (Optional / Opcional)

Automobile Information / Informacion de Automobile

Camper Agreement / Acuerdo de campista

In case of emergency please list the person authorized to pick up camper other than the parent / guardian. Only names listed below will be allowed to pick up / check out campers.

Payment

Payment Methods