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Counselor Application
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Indicates required field
Name
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First
Last
Address
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Line 1
Line 2
City
State
Zip Code
Country
Email
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Phone Number
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Birthdate
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I am applying to be a counselor for:
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Junior High Camp #1
Junior High Camp #2
Senior High Camp
Day Camp #1
Day Camp #2
Grades 1-4 Camp
Grades 2-5 Camp
Grades 4-6 Camp
Elementary Age 24 Hour Camp
Where are you employed?
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Choose One
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Full time
Part time
What skills, spiritual gifts or talents do you have which might be useful in this position?
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What training or experiences do you have which might be useful in this position?
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Name/Address of the Church you belong to:
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Line 1
Line 2
City
State
Zip Code
Country
Pastor's Name
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Church Phone Number
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Have you ever been convicted of or pleaded guilty to a crime?Choose One
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YES
NO
Have you ever been convicted of child abuse, sexual abuse, involved in any activities related to molesting or abusing children/youth, or are you on the sex offender registry for any reason?
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YES
NO
If yes to either of the above, please explain:
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Do you have a valid driver's license?
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YES
NO
I certify that all information provided in this application is true and complete. I understand that any false information or omission may disqualify me from further consideration, and may result in my removal if discovered at a later date. I affirm that I understand the policies of Lake Springfield Baptist Camp and agree to be bound by such policies. I further affirm that I will refrain from unBiblical conduct in the performance of my services on behalf of the LSBC camping program. I understand that the use of tobacco, alcohol and illegal drugs on not permitted on the camp grounds. I further understand that I am expected to conform to an exemplary standard of personal behavior consistent with the goals and policies of Lake Springfield Baptist Camp. Failure to do so will lead to my dismissal from camp. (Type your name here in lieu of signature.)
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Enter your name here in lieu of signature:
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