Riverside 2021 Summer Staff Application
Thank you so much for applying to work at Riverside this summer! You will not be able to close out of this application and return to it at a later time, so be sure that you have 30-40 minutes to complete the application. Otherwise you will have to start over. It is helpful to write your answers to the essay questions in another document, so that way you have them saved in case the internet crashes on you. If you would rather fill out a paper copy of the application, those can be found on our website at
https://www.riversidelbc.org/applications-summer-staff
. Contact Lute Olson at Lute@RiversideLBC.org with any questions or concerns.
* Required
Email address
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Your email
First Name
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Your answer
Middle Initial
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Your answer
Last Name
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Your answer
Preferred Name (if different than first name)
Your answer
I certify that by June 2021, I will be at least one full year out of High School.
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Yes
No
Phone Number
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Please indicate if this is your cell or home phone (i.e. 111-111-1111 Cell)
Your answer
Gender
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Female
Male
I am applying for...
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Cabin Leader
Adventure Leader
Wrangler
Maintenance
Other:
Required
Dates available to work...
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(i.e. May 30 - August 13) (Staff training begins May 30, and our last day of camp is August 13.)
Your answer
Current Address (include City, State, and Zip)
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(i.e. 3001 Riverside Rd. Story City, IA 50248)
Your answer
Is this your home or school address?
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Home Address
School Address
Other:
How long have you lived at this address?
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Your answer
Alternate Address (include City, State, and Zip)
Your answer
Is this your home or school address?
Home Address
School Address
Other:
Clear selection
For what dates will you be living at the alternate address?
Your answer
How long have you lived at this address?
Your answer
What is your father's name? (First and Last) (Please indicate if deceased)
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Your answer
What is your father's phone number?
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Your answer
What is your father's email address?
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Your answer
What is your mother's name? (First and Last) (Please indicate if deceased)
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Your answer
What is your mother's phone number?
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Your answer
What is your mother's email address?
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Your answer
What is the name of your home church/congregation?
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Your answer
Where is your home church/congregation located? (City, State)
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Your answer
What is the name of your pastor?
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Your answer
What is the name of your current church/congregation? (if different from home church/congregation)
Your answer
Where is your current church/congregation located? (City, State)
Your answer
What is the name of your pastor?
Your answer
Condition of health
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Your answer
Do you have any medical conditions that we need to be aware of for housing purposes? If yes, please explain.
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Your answer
Do you have any food allergies or dietary restrictions that we should be made aware of?
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Your answer
How did you hear about Riverside?
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Check all that apply
Past summer camper
A friend informed me
A family member informed me
Attended a retreat
Riverside website or social media
Other:
Required
Education Level
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Graduated high school
Earned a high school diploma equivalency
Other:
Required
What year did you graduate from high school?
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Your answer
What is your current and/or past college experiences?
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(Indicate where you are currently attending school, if you are.)
Your answer
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