McKenna Ranch Camp - Counselor Registration Application
McKenna Ranch Camp, owned and operated by Kathy McKenna Mueller, is a Christian centered youth camp. All campers experience the wonders of God's creation, which reveal the invisible attributes of God ~ clearly evident from His Creation.
McKenna Ranch Camp is licensed by the Texas Department of State Health Services (ID #250867). We consider our counselors to uphold the highest moral standards. Following submission, you will receive a confirmation email from camptheranch@gmail.com. Notification of acceptance or denial of the position will be communicated via email within one month, at which time salary will be discussed.
Name *
Your answer
Mailing Address *
Your answer
Email Address *
Your answer
Phone Number *
Your answer
Emergency Contact - NAME & RELATION *
Your answer
Emergency Contact - PHONE NUMBER *
Your answer
Age & Birth Date *
Your answer
Gender *
T-Shirt Size *
Which sessions would you be available to work? (check all that apply) *
Required
Allergies - FOOD *
Your answer
Allergies - GENERAL
Your answer
Allergies - MEDICAL *
Your answer
Insurance Coverage *
Please provide the company, name of the person who is primarily insured, the policy number, and the group number
Your answer
Medical Considerations *
Do you have any medical conditions of which we need to be made aware?
Your answer
Medications (Please list the medications that will be need to be administered at camp.) *
NOTE: The taking of prescription medication is the responsibility of the individual taking the medication and/or that individual’s parent or guardian. A Health Officer will be available during each session, and all medications (prescription and otherwise) must be turned in to the Health Officer upon arrival.
Your answer
Swimming Ability *
Do you have any certifications? (check all that apply)
Are you Christian?
Are you an active member of your church? *
What is the name of your church? *
Your answer
Please provide the name and contact information for your pastor or small group leader. *
Your answer
Do you serve in your church regularly?
If the answer to the above question was yes, please explain.
Your answer
Have you ever been convicted of a felony or misdemeanor? *
If the answer to the above question was yes, please explain.
Your answer
McKenna Ranch will conduct background checks on all of their employees and volunteers. Do you willingly submit to this background investigation? *
Child Safety Training *
All McKenna Ranch Camp employees and volunteers are required to have child safety training and certification that is approved by the state of Texas. Do you agree to take the steps necessary to complete this training?
Do you have experience working with children and teens? Please explain.
Your answer
Why do you want to work at McKenna Ranch camp as a counselor?
Your answer
Are you currently employed?
If the answer to the above question was yes, please explain.
Your answer
Do you smoke? *
Do you use drugs that are illegal in the state of Texas?
Do you have a valid driver's licence?
Will you be driving your own vehicle to camp?
What do you think your gifts and talents are? (please answer using a complete sentence)
Your answer
What classes would you be interested in teaching? (Please check all that apply)
Would you be willing to lead a Bible Study? *
Counselor Clothing Agreement *
Due to the nature of activities during the June 2019 summer camp sessions, each counselor will be required to bring shoes and clothing that is appropriate for hiking in rocky terrain. As a reminder, McKenna Ranch is a Christian organization; campers, CITs, counselors, and staff members are asked to dress modestly at all times.
Reference #1 *
Please provide a reference who can vouch for your dependability, responsibility, character, and trustworthiness. Please provide the name, phone number and email address of your reference, along with the number of years you have known them.
Your answer
Reference #2 *
Please provide a reference who can vouch for your dependability, responsibility, character, and trustworthiness. Please provide the name, phone number and email address of your reference, along with the number of years you have known them.
Your answer
McKenna Ranch Safety Statement *
The activities at McKenna Ranch Camp involve challenging the camper to experience and learn a variety of different skills. These activities are taught by mature, experienced instructors and safety is stressed with utmost importance. Activities may include: hiking, mountain climbing, overnight camping, swimming, dart board, sling shot, horseshoes, whittling, leather crafts, camp crafts, Indian lore, and natural sciences. Although many of these activities are inherently dangerous, every effort will be made to ensure the safety of everyone
McKenna Ranch Camp - Behavior Policy *
The McKenna Ranch Camp is a Christian youth camp, privately owned and operated, on the McKenna Ranch, in Del Rio, TX. Each camper is taught and instructed from the Bible (God’s Holy Word) and challenged with life lessons and memorization of scripture. We hold our campers, counselors, and staff to a high moral standard. Behavior that is destructive, manipulative, violent, reckless, sexual, or in any way inappropriate will not be tolerated. Foul language is prohibited. If safety and/or behavior standards are not followed by a particular camper, counselor, or staff member, then he/she will will be removed from camp, and legal action will be taken if necessary. McKenna Ranch Camp reserves the right to dismiss any counselor for misconduct or disobedience to camp rules.
Photo Release *
I hereby assign and grant to the McKenna Ranch the right and permission to use and publish the photographs/film/videotapes/electronic representations and/or sound recordings made of me or my child at all camp activities, and I hereby release the McKenna Ranch and the activity coordinators, and all employees, volunteers, related parties, or other organizations associated with the activity from any and all liability from such use and publication. I hereby authorize the reproduction, sale, copyright, exhibit, broadcast, electronic storage, and/or distribution of said photographs/film/videotapes/electronic representations and/or sound recordings without limitation at the discretion of the McKenna Ranch, and I specifically waive any right to any compensation I may have for any of the foregoing.
Health Record Release *
Due to the regulations set forth by the Texas State Department of Health and Human Services, McKenna Ranch must keep a copy of health records for each camper. Please be aware that campers will not be allowed to attend camp unless they provide a copy of these records. Upon arrival, these records must be presented to the Health Officer.
Informed Consent and Release Agreement *
In case of an emergency, I understand that every effort will be made to contact the individual listed as the emergency contact person. In the event that this person cannot be reached, permission is hereby given to the medical provider selected to secure proper treatment, including hospitalization, anesthesia, surgery, or injections of medication. Medical providers are authorized to disclose protected health information to any physician or health care provider involved in providing medical care to the participant. Protected Health Information/Confidential Health Information PHI/CHI) under the Standards for Privacy of Individually Identifiable Health Information, 45 C.F.R. §§160.103, 164.501, etc. seq., as amended from time to time, includes examination findings, test results, and treatment provided for purposes of medical evaluation of the participant, follow-up and communication with the participant’s parents or guardian, spouse, and/or determination of the participant’s ability to continue in the program activities. I have carefully considered the risk involved and give consent for myself to participate in camp activities. I approve the sharing of the information on this form with McKenna Ranch volunteers and professionals who need to know of medical situations that might require special consideration for the safe conducting of all activities at McKenna Ranch.I release the McKenna Ranch, its owner Kathryn McKenna Mueller, the activity coordinators, and all employees, volunteers, related parties, or other organizations associated with the activity from any and all claims or liability arising out of this participation.
Required
Digital Signature *
"By typing my name in the space below, I acknowledge that the information provided in this form is true and correct to the best of my knowledge. I have read, accepted, and understand the McKenna Ranch Camp's safety and behavior policy. I understand that by submitting this form, I am allowing McKenna Ranch Camp to conduct a background check and to contact my references."
Your answer
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