2017 Staff Application Form
SEP Silver Meadows Camp
Teen Camp: July 9 - 16th, 2017 (7 Days)

Staff should plan to arrive for required Staff Leadership training starting at 5 p.m. on Saturday, July 8, 2017.

Contact us at (204) 223-9691 or SepSilverMeadows@gmail.com

Email address
Gender
First Name
Your answer
Last Name
Your answer
Street Address
Your answer
City / Town
Your answer
Province / State
Your answer
Postal Code/ Zip Code
Your answer
Age Category
Cell Phone Number
Your answer
Other Phone Number
Your answer
Email Address
Your answer
STAFF POSITIONS
Please check ALL areas you would be interested in working:
Please Note: Dorm leads must be a member in good standing at a recognized church, have a letter of recommendation from your church pastor (physical letter, email from pastor or Pastor Recommendation Form) as to your regular attendance in your church for at least one year, and agree to and support the doctrines and beliefs of the Grace Communion International (GCI).
Required
Please List Other Activities or Comments:
If there are other activities that you have the skills and would be willing to run, please indicate. We are always open to new ideas.
Your answer
Certifications
Check ALL certifications or licences that apply:
Volunteer Experience
Have you worked at SEP Silver Meadows camp before?
List any gifts, training, education or other qualifications you have that has prepared you to work at SEP as a support worker or with children/youth:
Your answer
List all previous volunteer or paid work involving children or youth, including working at another summer camp:
Your answer
Accommodations
There are a limited number of spaces in the staff dorm, therefore we ask that, where possible, staff members provide their own sleeping arrangements such as tents, trailers, or shared accommodations. We will try to accommodate requests for specific sleeping arrangements but cannot guarantee your spot in the staff dorm
Please indicate where you plan on sleeping:
Please indicate any accommodation requirements, who sharing with, etc.
This helps us better understand which end is up!
Your answer
Emergency Contact & Medical Care Information
Emergency Contact Name
Your answer
Relationship to Staff Member
Your answer
Contact Phone Number
Your answer
Alternate Phone Number
Your answer
Health Insurance Number (and details)
Include Health Registration Number and Personal Health I.D. Number, as applicable.You must be covered by Provincial Health Insurance or equivalent medical insurance
Your answer
Name of Family Physician
Your answer
Physician's Phone Number
Your answer
Health Information
Please Check all the boxes that apply to you:
Required
Comments and more information
Please provide details of any above conditions or anything else the staff should be aware of or consider
Your answer
Signatures
Medical Release
The above information is collected in case you require serious medical attention and are unable to speak for yourself. The Camp requires staff to engage in a wide range of physically challenging activities, thus good health and fitness are important. For the safety and wellbeing of others, it is expected that you will be free of any communicable diseases prior to attending camp. If you have indicated you are on medications, it is your responsibility to store them securely and never in a camper dorm. During Camp there will be First Aid personnel on site who will deal with minor problems. If you require immediate serious medical attention, you will be transported to the local hospital or clinic. If requested, our Chaplin/camp leaders will be happy to pray for and/or anoint you. Precautions are taken for the safety and health of every staff member, but in the event of accident or sickness, SEP Silver Meadows, its staff and its volunteers are hereby released from any liability. I consent to let the Program Leaders seek medical attention for me if I am unable to communicate such a need myself and immediate attention is deemed by the Program Leaders to be required. Every effort will be made to contact your emergency contact immediately should medical attention be required.
Required
Photography Release:
During camp we will be taking pictures/video to capture the memories of our camp experience. Some of these will be used on our camp website during and following camp, and in other promotional materials for our camp. Note: children will not be identified by name on the website or any publication. Do you give your permission to use photos of yourself in this way?
Camp Release
I recognize the risks of physical and aquatic activities. I am satisfied with the precautions taken for my health and safety at camp. I release the above information, including provincial health care numbers due to Freedom of Information & Privacy regulations. I covenant not to sue and to release, indemnify and save and hold harmless, Grace Communion International Canada, all their affiliated organizations and boards of trustees or directors, officers, agents, volunteer workers and employees and Camp counsellors or helpers from and against claims or suits brought against the Church based upon or resulting from material, moral or bodily injuries sustained by me, arising out of, or in the course of, attendance at Camp.
Required
Staff Conduct Agreement
Legal / Insurance Requirements:
I, the undersigned, agree to donate my time as an SEP Silver Meadows volunteer without expectation of payment or compensation. I also understand that if accepted as a volunteer, this service relationship is mutually agreed-upon and that it can be terminated at will by either party. My primary focus as an SEP Silver Meadows staff member is to be part of a team providing recreational and spiritual guidance to the youth campers. I agree to partake in all activities as requested by the administration staff. I understand that in order to be accepted as a staff member at SEP Silver Meadows I must submit an original Criminal Record/Police Check with a vulnerable sector search, and Abuse Registry Check (if applicable in my province of residence). These documents must be dated within a year of the last day of camp. This clearance paperwork becomes the property of SEP Silver Meadows and will be kept on file indefinitely.
Required
Your Ability to Work with Youth:
All information will be kept in confidence by SEP Silver Meadows leadership and will not be disclosed unless required by law. We reserve the right to request clarification to any of these answers.
Do you have a criminal record for any misdemeanor or felony offense (summary offense or indictable offense)?
If YES, explain using "Other"...
Required
Do you have a criminal record for an offense involving drugs (use or possession), acts of violence or sexual misconduct (childabuse, child molestation, child neglect, sexual assault or rape)?
If YES, explain using "Other"...
Required
Have you ever been investigated by Child Welfare Agency or any other organization for suspected child abuse?
If YES, explain using "Other"...
Required
Have you ever been expelled from, or had your employment terminated by, any organization or employer for assault or violence against any person, or for assault, violence or impropriety with children, youth or vulnerable persons?
If YES, explain using "Other"...
Required
SEP Silver Meadows is a drug, tobacco and weapons-free site. The use of alcohol is permitted in designated areas only. Are you willing to refrain from the use of these substances while serving as a staff member of SEP Silver Meadows?
If NO, explain using "Other"...
Required
Code of Conduct Declaration:
I understand that I must be interviewed by SEP Administration staff, and/or ordained Grace Communion International Canada ministry. The purpose of this interview will be to give due diligence to the placement of SEP Silver Meadows staff. I agree to disclose any information that would impede or hinder my ability as an SEP Silver Meadows staff member to be with persons at risk. I authorize SEP Silver Meadows to investigate the statements contained in the application. I release SEP Silver Meadows and any person, organization or institution that provides SEP Silver Meadows with information concerning my background from any and all liability or claims that may result from the investigation, use, or disclosure of such information, and/or any damage that may result. I understand that any misrepresentation, falsification, or material omission of information on this application may result in my failure to receive an offer, the withdrawal of an offer, or, if I am accepted as staff, in my dismissal from a staff position. As a Staff member, I will ensure my conduct is defined by Jesus Christ, who in the two great commandments, stated that we are to have "love towards God, and love towards neighbour". I understand that the expectations at Camp include being respectful of others, actively and cooperatively participating in camp activities and events, behaving safely at all times, respecting the property of others (including camp property), reflecting modesty in dress and appearance as appropriate for the activity, abstaining from pairing off, sexual activity, bullying, use of offensive language, or possession or use of intoxicants, illegal drugs, tobacco products, or weapons. I understand that as a staff member, if I choose not to abide by the policies and rules of SEP Silver Meadows, or if my conduct or attitude undermine the wholesome, positive, and Christ-centered camp environment, I may be dismissed and return travel arrangements are made wholly at my expense. I am making application for voluntary service with SEP Silver Meadows. I hereby certify that to the best of my knowledge the information provided by me in this application is accurate, complete, and without error or material omission. I understand and agree to all of the above.
Required
Staff Applicant Name
By entering your name below you agree to abide by the camp rules and standards of the Camp
Your answer
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