Holy Helper Application
Sign in to Google to save your progress. Learn more
Email *
First Name *
Last Name *
Street Address *
City, State, Zip *
Phone Number *
Emergency Contact Name *
Emergency Contact Phone *
Emergency Contact Email *
How would you describe your gender? *
Date of Birth *
MM
/
DD
/
YYYY
What is your highest grade completed as of Spring 2024? *
What is your home parish? *
Health Insurance Name / Policy Number *
Please list any food allergies or dietary restrictions you may have (type NA for none) *
Please list any other allergies you may have (type NA for none) *
Please list any medical concerns or medical disorders that we should be aware of that may or may not require medication. All medications must be stored securely (type NA for none) *
Please list any emotional, psychological or social well being concerns that we should be aware of (type NA for none) *
I give permission for the use of my image in photos and/or videos [without identifying names] in our Camp Koinonia newsletters, website and social media. *
Have you completed the Create a Safe Environment (CASE training) in the past 3 years? *
Have you participated and/or staffed at Family Camp before? If so, check all that apply *
Required
Which is your preferred first choice week to staff? *
What is your preferred second choice week to staff?
Clear selection
What areas would you like to help with? Please check all that apply *
Required
Please check any certifications that you may have
Please provide the name and email address of a personal or professional reference *
If you have any questions or concerns, please list below.
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Camp Koinonia, Inc.. Report Abuse
Google Forms