2018 Van Es Counselor Registration
Want to serve as a counselor at Van Es this summer? Fill out the form and you'll be contacted soon!
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 *
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/
DD
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YYYY
Cell Phone Number *
Your answer
Home Church (Where do you worship?) *
Your answer
Camp Week You'd Like to Serve *
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 to get yours one weekend.
Have You Served at Van Es Before? *
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 helpful as a counselor? *
Your answer
Tell me (Pastor Matt) about the important aspects of your spiritual journey over the past year? *
Your answer
Reference Person #1 (First and Last Name) *
Your answer
Reference Person #1 (Phone # & Email) *
Your answer
Reference Person #2 (First and Last Name) *
Your answer
Reference Person #2 (Phone # & Email) *
Your answer
Emergency Contact Name *
Your answer
Emergency Contact Phone Number *
Your answer
Emergency Contact (Relationship to you) *
Your answer
Photo Permission *
Do you give permission to the Van Es Camp Board to use pictures of you or any photos you take for our website or other 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.
Police Background Check *
Every volunteer is required to bring a current police background check with them to Van Es. Because each city is different, you might need up to one month to receive your clearance. Please get yours as soon as you are able, and know that they will be kept in the strictest of confidence. You can mail them to Matt Gillard at 1803 119 St. SW Edmonton, AB T6W 1W4. If you do not have a background check with you, you will not be able to be a counselor this summer.
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