Pacific Coast Japanese Conference / Upcoming Events / Camp Staff Registration

This is for camp staff only. Payment must be sent in separately by June 1st, 2016. See your program director for more information.

First Name

Last Name

Male

Female

Birthdate (month/date/year)

Street Address

City

State

Zip Code

Email Address

Home Phone

Cell Phone:

What is the best way to reach you ? (Email, text, phone, Facebook)

T-Shirt Size

Small

Medium

Large

X-Large

Church Registering Through

Program

Juniors (4-5th)

Middle High (6-8th)

High School (9-12th)

College

Position: you must be at least 18 years old and at least two years out of the program for which you are applying.

Program Director

Core Staff

Cabin Leader

Worship

Is this the first time serving in this position?

Yes

No

I will be at camp on Saturday, July 16, for Pre-glow

Yes

No

Transportation to and from Camp (The staff bus is currently FULL)

I will provide my own transportation

QUESTIONS: Please answer the following quesiton

Have you received Christ as your Lord and Savior? If so, when?

Tell us about when you accepted Christ

Explain why you believe God has called you to serve in this position:

How often do you attend church?

In what areas have you served in your local church?

What other ministries have you served in outside of church (InterVarsity, Campus Crusade, AACF)?

What are your 3 greatest strengths?

What are 3 areas you need improvement in:

Explain the Gospel and how it is relevant to the program you are applying for:

Describe the most challenging part of your spiritual journey and how you responded:

On a scale of 1-10 with 10 being healthy, how would you rate your spiritual health and why?

What experience in the past year has impacted your life the most and why / how?

What are your top 3 giftings / talents ?

What is your favorite thing to do in ministry?

Have you had a background check with the PCJC? If so, when?

If not, please go to:

https://www.ministryopportunities.org/Application.aspx?oid=1492

You may be contacted for a follow up interview. When is the best time to set up an appointment?

I understand that a criminal background check is required and I agree to have this done.

• I understand and agree to a health screening upon 24 hours of arrival to camp.

• I authorize any references listed in this application to give any information (including opinions) that they may have regarding my character and fitness for this work. I release all such references from any liability for furnishing such evaluations provided they do so in good faith and without malice.

• My priority at camp will be the students and the program within which I am serving.

• I understand that this is a Christian camp with Christian values. I agree to follow the standards set by the camp program and by Redwood Christian Park.

• I will attend all training meetings and make them a priority in my schedule.

I agree to the above terms

REFERENCES

Reference #1 Name (Pastor / Ministry Leader)

Relationship

Phone Number

Email Address

Reference #2 Name

Relationship

Phone Number

Email Address

HEALTH FORM

Special Needs: Please list any medical limitations, allergies, dietary needs, medications taken or if you have a learning or behavioral disability (ADD, dyslexia, etc.) in the section below, if needed.

Have you had a tetanus shot within the last ten years?

Yes

No

Give date if known:

Name of primary person who holds the insurance:

Name of Medical Insurance Carrier:

Group/Family Number:

Medical Record Number:

Physician's Name:

Physician's Phone Number

EMERGENCY CONTACT INFO

Emergency Contact 1:

Relationship:

Primary Phone Number:

Secondary Phone Number:

Emergency Contact 2:

Relationship:

Primary Phone Number:

Secondary Phone Number:

LIABILITY RELEASE FORM

EVERYONE must sign a Liability Form if you will be in the Junior, Middle High, Senior High, Genesis, Young Adult or Adult program.

By initialing below, I hereby hold harmless the management, staff and trustees of Redwood Christian Park (RCP) and the coordinators and staff members of the Pacific Coast Japanese Conference of the Free Methodist Church (PCJC) for any and all events of said conference, and I understand that any accidents or sickness incurred by myself or anyone that I am responsible for as participants of this particular event will not be covered by either organization.

I understand that all recreational activities have the inherent possibility of injury to person or property and may result from my participation in any activities on the Redwood Christian Park premises, such as swimming, hiking, volleyball, basketball, paintball, climbing wall, activities on the ropes course and all other available recreational options and activities. I also understand that there are inherent issues of safety as related to the mountainous terrain of Redwood Christian Park and that I am responsible for my own actions in this regard.

I understand that this Liability Release constitutes a full and complete release from liability insofar as Redwood Christian Park is concerned, and by signing below, I hereby hold harmless the management and trustees of Redwood Christian Park, Pacific Coast Japanese Conference and the RCP and PCJC camp staff of responsibility for any and all injury or damage to me, any member of my family, or any person whom I am responsible for at this camp.

Initial:

Date:

Fees:

$285 Registration

$9.00 Camp Picture

If receiving a scholarship, please give church name and amount below

Please make checks payable to PCJC Family Camp and send to

PCJC Family Camp

PO Box 1659

Lomita, CA 90717

Please send in payment by June 1st, 2016

Checklist

Completed application form

Payment

In submitting this application, please understand that as an applicant you are not guaranteed a position into the program that you have applied for. Under certain circumstances, our Program Directors may determine that you are best fit or will be better utilized in a different program. Regardless, once your application process has been completed, one of our Program Directors will contact you and update you on the status of your application. Thank you for your willingness to serve.

Initial:

Date: