Application – Jr. Staff Name (required) Address (required) City (required) Zip (required) Email (required) Phone Age (required) Date of Birth (required) Do your parents approve of you working at camp? Parents Names? Are you covered by medical insurance? YesNo Insurance Company? Policy Number? Home Church Pastor What is your involvement at church? Name of reference # 1? Email of reference? What is your relationship with this person? Name of reference # 2? Email of reference? What is your relationship with this person? Do you have any musical abilities you would be willing to use at camp ? Desired Position ---Junior CounselorKitchen (dishes)Grounds (mowing & weed whacking)Combination of above How many weeks would you like to work at camp? OneTwoThreeAs many as possible Are their certain weeks when you are unavailable to work at camp? NoYes If "yes" what weeks. Are you able to pay for your one week of teen camp before serving on staff? YesNo Have you worked at camp before? YesNo Where and when have you worked at camp? What size polo shirt do you wear? Please share your salvation testimony. Please share what God is doing in your life in recent months. Please provide any other information that may be helpful. Have you ever been accused of, participated in, or been convicted of any sexual abuse? YesNo By typing you name, you are signing that the above information is true and accurate. Perhaps you recognize some of the delightful young people that work at Servant’s Heart last year. 2017 Summer Staff If you do not receive a preliminary response within 20 days, please contact us.