Surname: Given Name:

Birthdate [mm/dd/yy]: Home Phone (area code first, no spaces):

Address - Street:

City:

Province: Alberta British Columbia Saskatchewan Manitoba Yukon NWT Ontario Quebec PEI Newfoundland New Brunswick Nova Scotia

Postal Code :

Email address:

Present Occupation (if student, list school and grade):

Other work experience:

Home church or religious affiliation:

Camp Experience (as a camper, staff &/or volunteer):

Training & experience (children, recreation, environment, cooking, etc):

Hobbies and interests:

Canoeing - boating Training/experience:

First Aid Certificate:

Other Certificates [Food Safe]:

Disabilities & medical condition information:

Are you available for:?

[1] Jun 28. to August 31.2003Yes No

[2] May long weekend?Yes No

Please list 3 references and check with them to expect a call.

[1] Name: Phone:Occupation

Relationship:

[2] Name: Phone:Occupation

Relationship:

[3] Name: Phone:Occupation

Relationship:

In filling out this application, bear in mind that this is a Church Camp. as a prospective leader, we want you to make some significant contribution to the Christian emphasis within the camping program. How can you contribute to this emphasis?

Any other contribution you could make or comments to assist your application:

By submitting this application I guarantee that this form contains valid information. I also declare that there are no reasons why I should not be hired to work with children.

You will be contacted if you are selected for an interview. Please bring a printed and signed copy of this form and photocopies of any certificates to the interview.
Either click to reset or submit the completed form.
View our Adobe "pdf file (page 12-13)" to PRINT this form.

contact: Judy Symington, [250]546-6720