Camp Crew Application

Personal Information

Select a Summer Camp Crew Application*

First Name*

Last Name*

Date of Birth*

MM slash DD slash YYYY

Age*

Gender*

Marital Status*

Address*

City*

State*

Zip*

Phone*

Email*

Emergency Contact*

Emergency Number*

Church*

Church City*

Pastors Name*

Pastors Email*

Pastors Number*

Please answer the questions below

Have you accepted Christ as your Savior?*

When did you accept Christ?*

Are you baptized in the Holy Spirit?*

When did you get baptized in the Spirit?*

Do you use tobacco?*

Drink alcoholic beverages?*

Use nonprescription drugs?*

Do you have any physical handicap or condition preventing you from performing certain types of activities?*

Handicap Explain

Have you ever been convicted of a criminal offense (excluding minor traffic violations)?*

Crime Explain

List two personal references (excluding your pastor, youth pastor, and family members)

Reference 1 Full Name*

R1 How long have you known this person?*

R1 Phone*

Reference 1 Email*

Reference 2 Full Name*

R2 How long have you known this person?*

R2 Phone*

Reference 2 Email*

Camp experience and commitment

Past Masterpiece Gardens camp staff experience?*

Years served and positions

Do you have any medical training?*

Medical Explain

What weeks of camp can you commit to (check all that apply)?*

June 3-7

June 10-14

June 17-21

June 24-28

July 1-5

July 8-12

What weeks of camp can you commit to (check all that apply)?*

July 15-19

July 22-26

July 29-Aug 2

What weeks of camp can you commit to (check all that apply)?*

June 3-7

June 10-14

June 17-21

June 24-28

July 1-5

July 8-12

July 15-19

July 22-26

July 29-Aug 2

Application Statement

Are you willing to abide by the camp rules, be given any position or assignment, be placed in any dorm, and if need be, go beyond the duties of your assigned position?*

The information I have provided in this application is correct to the best of my knowledge. I have carefully read all the information provided in the application form. I authorize any references or churches listed in this application to give you any information they may have regarding my character and fitness for Youth Camp, and I release all such references from liability for any damages that may result from furnishing such evaluations to you.*

Should my application be accepted, I agree to be bound by the policies of camp, and refrain from unscriptural conduct or conduct the camp leadership may feel inappropriate, in the performance of my service. I will fully cooperate in spirit. I hearby authorize the Peninsular Florida District Council of the Assemblies of God, Inc to conduct a background check.*

Digital Signature*

Today's Date*

MM slash DD slash YYYY

I understand that after I submit this application, my Pastor will be asked to fill out the Pastoral Recommendation Form at youth.penflorida.org/pastor*

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