Counselor Registration 2017
Hoping to serve as a counselor at Van Es this summer? Fill out the form so we can contact you.
First Name *
Your answer
Last Name *
Your answer
Email Address *
Your answer
Mailing Address *
Your answer
City *
Your answer
Postal Code *
Your answer
Date of Birth *
Counselor must be 18 by July 1 of this year. Additionally, counselors must be at least 19 for Jr. High and 22 for Sr. High.
MM
/
DD
/
YYYY
Cell Phone Number *
Your answer
Home Church (Where Do You Worship?) *
Your answer
Camp Weeks You'd Like To Serve *
You can request to serve at multiple camps.
Required
Medical Concerns *
Please write "None" if you do not have any.
Your answer
Dietary Needs *
Please write "None" if you do not have any.
Your answer
Current First Aid Certificate *
Camp is better off if you have one... so please consider taking the time one weekend to get it.
Have You Served at Van Es Before?
In What Capacity Have You Served at Van Es Before? *
Your answer
What personal experiences do you hope to gain through serving at Van Es this summer? *
Your answer
What interests or hobbies do you have that could be used at camp? *
Your answer
What interests or hobbies do you have that you can offer as a leader at camp? *
Your answer
Tell me (Pastor Matt) about the important aspects of your spiritual journey over the past year. *
Your answer
Reference Person #1 (First & Last Name) *
Your answer
Reference Person #1 (Phone # and Email) *
Your answer
Reference Person #2 (First and Last Name) *
Your answer
Reference Person #2 (Phone # and Email) *
Your answer
Emergency Contact (Name) *
Your answer
Emergency Contact (Relationship to you) *
Your answer
Emergency Contact (Phone Number) *
Your answer
Photo Permission *
(Do you give permission to the Van Es Camp board to use pictures of you or any photo's you take for our website or promotional materials within the Moravian Church?)
Emergency Consent *
In the unlikely event of an emergency, every effort will be made to contact the parents/guardian or emergency contact. If they cannot be reached I hereby give permission to be medically attended to as deemed appropriate by the Camp Director and First Aid Attendant, including, as necessary, hospitalization.
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms