Volunteer Form

Personal Information

First Name

Last Name

MI

Camp Name (if you have one)

Cell Phone (xxxxxxxxxx)

Home Phone (xxxxxxxxxx)

May we text message you?

Yes
No

Gender

Male
Female

Email Address

Birth Date

Address

City

State

Zip

Home Church

Home Church City

Home Church State

School/Work History

Current School

Current Employment

Skill/Interest Overview

What camps, programs, and age groups have you previously served? What type of experience do you have working with kids?

Please give a brief statement of your personal faith and how you would share it.

Are there any activities that you are not willing to participate in?

Desired Positions

Please select all the summer camp jobs that you are WILLING to do (full time or part time).

Counselor Positions

Little Chief Counselor
Big Chief Counselor
Jr. High Adventure Counselor
Outpost Counselor

Support Staff

Kitchen Helper
Dishwasher
Housekeeper
Maintenance
Groundskeeper
Office Worker
Nurse Assistant
Photographer/Video Editor
Computer Operator

Of your selected positions, please list your top three preferences in order.

1.

2.

3.

Certifications

List the type and expiration date of all CURRENT certifications and licenses you may have.

Waterfront/ Lifeguard

Medical

Wilderness

Archery

Food Service

Other

Work Requirements and Abilities

Can you commit to the set up dates: July 31st-Aug 1st, 2010

Yes
No

Can you commit to the week of camp: August 1st-August 6, 2010 (Counselors please arrive Saturday evening, July 31)

Yes
No

Can you commit to the clean up date: Aug 7th, 2009

Yes
No

Are you bilingual?

Yes
No

If yes, what language(s)

Do you have any impairment that may limit your performance

Yes
No

If yes, describe

Are you legally eligible to seek employment in the U.S.

Yes
No

Have you been convicted of child abuse or sexual abuse

Yes
No

If yes, describe

Have you ever been convicted of a felony or misdemeanor

Yes
No

If yes, describe

Do you give permission for PSD Outdoor Ministries to do a background check

Yes
No

Social Security # (xxx-xx-xxxx)

Driver's License #

Driver's License State

Driver's License Type

Signature

I verify that I have completed this application form, that all the information is true to the best of my knowledge, and that I am herewith submitting it to PSD Outdoor Ministries. If my services as a volunteer are utilized, I understand that any false statements on this form are grounds for immediate dismissal.

I agree

Please type your full first and late name and the date as your signature

Full Name

Date

PSD outdoor ministry

Volunteer Form

Personal Information

School/Work History

Skill/Interest Overview

Desired Positions

Certifications

Work Requirements and Abilities

Signature

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