Please select the week you wish to serve at Camp BASIC this year: (*)
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Personal Information
Full Name: (*)
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Street Address: (*)
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City: (*)
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State: (*)
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Zip Code: (*)
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Phone Number (*)
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E-Mail:
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Age: (*)
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Birth Date mm/dd/yyyy (*)
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Gender: (*)
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Parent/Gaurdian Name(s):
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Have you every volunteered at Camp BASIC before? (*)
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If so, when?
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Have you ever been convicted of a crime, other than a minor trafic ticket? (*)
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Indicate what volunteer position you are interested in: (*)
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If you checked "Other" above, please tell us what position:
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What is your T-Shirt Size?
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Church Information
Are you baptized: (*)
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Are you confirmed: (*)
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Church Name:
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Synod Affiliation:
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If you checked "Other" above, please indicate:
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Church City:
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Church State:
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Pastor's Name:
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Pastor's Phone:
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Previous Camp Experience
Have you ever attended or volunteered at a camp? (*)
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If Yes, please describe the type, what you did, and length of stay:
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Have you every worked with individuals who have a developement disability?
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If Yes, please describe:
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Describe an special training you may have:
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Please check off any Special Skills & Interests that cold be used at Camp
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What instrument(s) do you play?
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Can you lead people in singing? (*)
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Can you describe for us any other special skills and interests?
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Current Red Cross or other Certification:
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If Other, please list for us your other cirtifications
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May we release any of the following informaiton to other volunteers and starff?
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Any other informaiton the Camp Director should know about you:
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Releases To Be Checked by the Participant or the Participant's Guardian
The following releases
must be checked and dated by the participant or the participant's guardian. If the releases are not checked, any participant who is a minor will not be permitted to attend Camp.
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(*)
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The Date of agreement for this conduct release (*)
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(today's date)
Photo/Public Relations Consent and Release
I understand that Camp BASIC may wish to use my/my child's name, photograph and / or stories with its work and that it needs appropriate consent to do so. Pictures may be taken for the purpose of sharing with the group, for sharing with area churches, the community and on the Camp BASIC web site.
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Participant's Name for Photo and PR Release:
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Parent's Name, if participant for Photo PR Release is a minor:
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Date you agreed to our Photo PR Release: (*)
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(today's date)
Authorization For Treatment
Authorization for the treatment of (Participant's Name): (*)
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You must check the box to grant the following permissions (*)
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Date of Authorization for Treatment (*)
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(today's date)
Emergency Contact Information
Emergency Contact Participant's Name: (*)
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First Emergency Contact/Parent Information, please supply us with a name, address, city, state, zip, home phone, work phone, and cell phone. (*)
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Second Emergency Contact, please supply us with name, home phone, work phone, and cell phone: (*)
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For Participants who are minors:
Please be aware that Camp BASIC does not have trained medical professionals on staff. In the absence of a licensed nurse, Camp Directors will pass out requested over-the-counter medication. For this reason it is very important that all of you let Camp staff know what over-the-counter medications you will allow Camp staff to dispense.
If needed, which medicatons may your child take?
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Any additional information concerning health or medications for this participant?
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Permission To Attend Camp BASIC
only for minors
Minor Participant's Name:
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Parent or Guardian of Minor who will participate:
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Date when permission was given for minor to participate:
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(today's date)
Are you a human?
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