GKC Camp Counselor Application 2019 (For All Camps)

2019 Camp Counselor Application

(For All Camps)

On behalf of the Camp and Conference Committee of the Greater KC Region, thank you for volunteering to serve as a camp counselor this summer. We suggest that you scroll down the page to see the information requested before beginning the registration process.

Every volunteer must fill out an application.

If you have any questions, call or email Rev. Shandra Yost Soltani before beginning the online registration.

To Complete an Application You Will Need the Following Information:

Volunteer Name
Date of Birth
Gender
Mailing Address, City, and Zip
Email Address that is checked at least once per week
Name & Phone Contact for Volunteer (and for Parent/Legal Guardian if volunteer is under the age of 18)
1 Emergency Contact (Name and Best Phone Number)
Name of Your Church and City/Town
Medical Information (ie: Insurance, Doctor Name & Number)
If volunteer takes medication, we will need that list with dosage information.
Vaccination History (yes/no questions)
Emotional/Social Health Questions (yes/no)
General Health Questions (yes/no)
Permission to conduct a background check

If you are counseling additional camps this summer, please list them here:

What Congregation do you attend? (Choose from the dropdown menu):

Volunteer Information

Volunteer First and Last Name

Gender

Male
Female

Volunteer Date of Birth

T-Shirt Size

Is this the first year you have counseled a Tall Oaks camp?

Updates about camp are sent via email. Please list an email address that is checked at least once a week.

Volunteer Mailing Address

Parent/Guardian with Legal Custody (if Volunteer is under 18)

Parent/Guardian First and Last Name

Parent/Guardian Address

Preferred Emergency Phone Number

Emergency Contact

First and Last Name

Preferred Emergency Phone Number

Relationship to Volunteer

Insurance Information

If you require medical treatment while at camp, your health insurance information will be used at the hospital. Please provide that information below.

Health Insurance Carrier or Plan Name

Policy or Group #

Date of Birth of Policy Holder

Volunteer Medical Information

This section helps our director staff and medical personnel know about your medical needs including:

Any Medications you will take during camp
Over the counter medications allowed or not allowed
Allergies, diet, nutrition, and vaccinations
General health questions and any restrictions
Social & Emotional Health

Medications

"Medication" is any substance a person takes to maintain and/or improve their health. This includes vitamins & natural remedies. All medications are collected, stored, and distributed by either a volunteer adult with a health care background or by camp health care personnel.

Please list ALL medications (including over-the-counter or non-prescription drugs) taken routinely. Bring only enough medications to last the entire time at camp. Keep it in the original packaging/bottle that identifies the prescribing physician (if a prescription drug), the name of the medication, the dosage, and the frequency of administration.

Please choose one:

I WILL NOT take any daily medications while attending camp
I WILL take Daily Medication during camp

Please list ALL medications if you checked the previous box:

Please choose one:

Camp staff HAS PERMISSION to administer over-the-counter medications as necessary.
I SHOULD NOT be given any over-the-counter medications.
Camp staff HAS PERMISSION to administer over-the-counter medications as necessary, EXCEPT:

Please list any over-the-counter medications that SHOULD NOT be given to you:

Name of Your Primary Doctor

Primary Doctor's Phone Number

Brief Medical History

Help our director/staff understand your medical history so they can better care for you.

Allergy Information (check all that apply):

No known allergies
Food
Medicine
The Environment

Briefly describe what you are allergic to, the reaction seen, and how it is treated:

Diet and Nutrition

I eat a regular diet
I eat a regular vegetarian diet (that includes dairy/eggs)
I have special food needs

Briefly describe any special food needs:

Vaccinations: (please check all that you have been vaccinated for or received booster shots) *

Social/Emotional Health (check all that apply to you):

Ever been treated for emotional or behavioral difficulties or an eating disorder?
During the past 12 months, seen a professional to address mental/emotional health concerns?
Had a significant life event that continues to affect your life?
Volunteer is emotionally and socially stable.

Please provide a brief description for any item you checked:

Please explain any of the above issues if checked:

What have we forgotten to ask? If your explanation about your health exceeded the space above, please provide additional information that you think is important or that may affect your ability to fully participate in the camp program by emailing Rev. Lara Blackwood Pickrel ([email protected]).

Consent and Release

Permission to Photograph

With your permission, the Greater KC Region's Ministerial staff and our volunteer camp staff (counselors and directors) will photograph or video tape you for the express purpose of promoting the Region's Summer Camp (outdoor ministry), Children's Ministry, and Youth Ministry programs through print media, digital media, or Internet platforms. Further, the staff of Tall Oaks Conference Center (the facilities the Greater KC Region rents to host our Summer Camp program) has permission to photograph or video tape you for the express purpose of promoting their facilities and ministry of hospitality through print media, digital media, or Internet platforms. Below you can choose to NOT give your permission.

I/We Authorize the Region to photograph or video tape me.

I/We Do Not Authorize the Region to photograph or video tape me.

In the case of a volunteer who is under the age of 18, the undersigned person represents that he/she is the custodial parent/legal guardian of the above identified participant. The volunteer has my/our permission to attend the camping program sponsored by the Christian Church (Disciples of Christ) in Greater KC from May 1, 2019 to August 31, 2019.

In case of medical emergency, I/We understand that every effort will be made to contact a parent or guardian of the volunteer. In the event I/We cannot be reached, I/We hereby grant permission to the camp staff to hospitalize, secure proper treatment for and to order injection, anesthesia or surgery for child while attending camp. I/We further release the camp director(s), volunteer counselors, onsite staff, and the Christian Church (Disciples of Christ) in Greater KC from responsibility and liability for any accidents or illnesses occurring during camp. I/We also authorize the camp director or medical supervisor to dispense non-prescription drugs (i.e. Tylenol; ibuprofen) if the situation warrants. I/We understand that the camping experience grows in intensity as the week progresses. I/We recognize that missing any part of the week compromises my child’s experience of intentional Christian community and affects both my individual child and the camp community as a whole. I/We know that the demands outside this camp event may be in conflict with the commitment to spend a week apart in Christian camping, and I/We have chosen to have my child spend a week at camp uninterrupted. Thus, I/We agree to not text or call my child/youth during the week of camp.

The participant has no physical or mental disabilities that would impair their participation except as noted above. I/We understand that the information provided on this form will be kept confidential and shared only as necessary to provide care of the participant.

By checking this box I/We state that I/We have read and agree to the Consent and Release information above.

Checking this box represents your digital signature and authorization. Your underage volunteer cannot register for camp without you accepting the "Consent and Release" information.

Community Covenant for Volunteers

Our summer camp, retreat, education and mission trip experiences depend on a commitment to living in intentional Christian community by the participants and the adult volunteers. To do so, we agree to a covenant that helps manage our relationships with one another, our behavior within community, and as a community. We require all participants to read and agree to our Community Covenant below.

Summer camp, retreat, mission trip, or education trips are an opportunity to come to know God while living in intentional Christian community. To ensure every person’s worth as a child of God and each person’s safety, all participants (youth, children, and adults) follow this Community Covenant.

I will participate fully in all activities.
I will be respectful to all persons and the camp environment at all times.
I understand that as a volunteer, I am present for campers' safety, for their questions about life and faith, and I am responsible to uphold the Region’s policies and boundaries as well as that of the camp facilities. I will behave in ways that are worthy of that respect and trust.
The Region practices, “Two Deep Leadership” to ensure the safety of all participants. I will engage with campers using this model, and will never be alone with a camper.
I will respect the personal items of other participants (children, youth, and adults) and respect the personal space and other person's physical autonomy.
Accidents happen. I understand that I and/or my family could be held financially responsible for any repairs needed to property as a result of my actions.

I understand and accept that if I am found with, or participate in any of the following, that I could be sent home from summer camp, from a retreat, education trip, or mission trip experience at my own/my family's expense. I also understand that being sent home may limit or disqualify my participation in summer camp, retreats, education or mission trips in the future.

I will not bring weaponry of any sort (knives, firearms, etc.) to camp.
I will not bring or consume illegal drugs, alcohol, or tobacco of any sort (or bring/consume prescription drugs that are not prescribed to me).
I will not steal anything from anyone.
I will not physically harm another camper or adult.
I will not participate in sexual activity of any kind.
If I behave consistently in a way that disrespects the adults, other campers, or the facility, or that does not reflect the grace and love that is expected of persons who claim Christian faith.

Summer Camp is ideally Cell Phone Free Zone for campers. Cell phones, Internet hotspots, electronic entertainment devices, game devices, or devices capable of connecting to cell towers often detract from the camp experience. However, volunteers need to have their phones with them at all times for the sake of safety and communication. Aside from moments when cell phone use is necessary for those two reasons, I will limit my cell phone and electronics use so that I am fully present throughout the camping experience.

I look forward to spending time in community with those who share my interest in exploring Christian faith and the practice of Christianity as we play, pray, study, worship, and serve one another following the example of Jesus.

By checking this box I provide my digital signature and agree to uphold the Community Covenant for Volunteers.*

You cannot apply to volunteer for camp, retreat, study trip, or mission trip experiences without agreeing to uphold the Community Covenant for Volunteers

Background Checks

Please list the preferred address (email or mailing address) where you can receive mandatory background check paperwork. Once you receive the paperwork, please fill it out and return it promptly so that your background check can be run. You cannot be approved to counsel a camp without having a background check.