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RFKC NWA Returning Staff Application - Summer 2021
Camp Dates for Summer 2021: June 6-11
Mandatory Training Dates:
May 1, 2021; 9-3pm
All information is held strictly confidential. This form must be completely filled out. The information is vital to your acceptance and possible placement as a counselor or support staff.
This form must be completed in one sitting. Please allow about 30 minutes to complete.
You will need to gather your driver's license number and list of medications.
Please let us know if you have any questions regarding this application: We look forward to ministering with you.
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Email *
Today's Date *
Current Drivers License # *
(We will take a photocopy of your license at training)
Last four digits of your Social Security Number *
Your Full Social Security number may be required separately to obtain the criminal background check from a third party.
Last Name *
First Name *
Gender *
Birthdate *
Address (street, city, state, zip) *
Age *
Marital Status *
Occupation *
Name of Employer *
Number of Years Employed at Current Employer *
Phone Number *
Emergency Contact Name *
Emergency Contact Phone Number(s) *
Emergency Contact Relationship *
T-Shirt Size *
Certifications *
Select all certifications that you already have.
Have you worked with or associated with children of abuse, neglect or abandonment this past year? *
If yes, in what way?
Please describe why you wish to return as a volunteer for RFK. *
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