| Please complete and mail to the director with health
form by March 1,2008. Make a copy for your records. Name
_____________________________________________________
Address ____________________________________________________ ____________________________________________________ E-mail address ___________________________ Phone (_____)_________ Birthdate _______________ Date of application ______________ T-shirt size___________ Name and address of the church you attend. In what way are you involved in the worship and/or ministry of your church or explain your involvement in any church related and religious activities?
Pastor's signature _________________________ My signature verifies that this person is involved in my church on a regular basis. Please explain in a few words why you want to serve at Camp Luther.
I would like to serve in this capacity: __Dean __Counselor __Chaplain __Nurse __Office Staff __Teacher* __Spiritual Director __Webpage photographer __Psychologist __Director *Teacher areas: __Bible __Catechism __Camp Curriculum __Music __Nature __Crafts__Sports __Newspaper __Swimming __Creative Arts In which program would you like to serve? ___ Jr. Program (Grades 3-5) ___ Inter. Program (Grades 6-8) ___ Sen. Program (Grades 9-12) Do you have certification in any of the following? ____ Life Saving ____ First Aid Have you taken the training for “Safe Guarding God’s Children”? ________________ Where and when?
______________________________________________________ Please attach a copy of your certificate with this application.
What would be the greatest strength that you would share with the program at Camp Luther?
Please list three references. Please ask your references for permission to use their names. At least on reference should be a member of your church. Letters from two of the references will be required for new applicants. Please print. Name Address Phone 1. ______________________________________________________________________ 2. ______________________________________________________________________ 3. ______________________________________________________________________
Have you ever been discharged or forced to resign from employment or
a volunteer role? If yes, please give the details, including the name of the employer or group.
Have you ever been convicted of a crime or are you under charges for any offense against the law, other than minor traffic violations? ____no ____ yes If yes, please give the details. ________________________________________ _____________________________________________________________ _____________________________________________________________ CERTIFICATION (Please read this statement carefully before signing) I hereby certify that my answers to the above questions are true, complete, and correct. I understand that false answers on this application may be grounds for immediate dismissal from Camp Luther. I also understand that the above answers are subject to verification. Signature _______________________________________ Date _________ Due March 1, 2008 Please return this application and health form to :
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