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Indiana Camp & Conference Center
CAMP VOLUNTEER REGISTRATION
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Volunteer Applicant Information
Name
*
Gender
*
Male
Female
Date of Birth
*
Month
January
February
March
April
May
June
July
August
September
October
November
December
Day
1
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Year
2024
2023
2022
2021
2020
2019
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2016
2015
2014
2013
2012
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2009
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1921
1920
1919
1918
1917
1916
1915
1914
1913
1912
1911
1910
1909
1908
1907
1906
1905
1904
1903
1902
1901
1900
Mobile Phone Number
*
Volunteer Options
Camp(s)
*
Kids Camp (ages 8-9)
Kids Camp (ages 10-11)
Jr. High Camp (ages 12-14)
Sr. High Camp (ages 15-18)
Volunteer Role(s)
*
Dorm Supervisor
Recreation Staff
Kitchen Helper
Additional Applicant Info
T-Shirt Size
*
(Choose One)
Small
Medium
Large
X-Large
XX-Large
XXX-Large
Emergency Contact
*
Emergency Contact Number
*
Have you been baptized in the name of Jesus?
*
Yes
No
Have you received the Holy Ghost?
*
Yes
No
What is your spiritual status?
*
Excellent
Good
Fair
Have you ever been convicted of a crime?
*
Yes
No
Upload Drivers License
*
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SS #
*
We will do a background check to ensure the safety of our children. By completing this form you consent to have your background checked.
Background Check Agreement
*
I hereby authorize the duly authorized officials of the Indiana District UPCI to request the police/sheriff's department to release information regarding any record of charges or convictions contained in its files, or in any criminal file maintained on me, whether said file is a local, state, or national file, and including but not limited to accusations and convictions for crimes committed against minors, to the fullest extent permitted by state and federal law. I do release said police/sheriff's department from all liability that may result from any such disclosure made in response to this request. I will abide by the camp rules and dress code, and will fully cooperate with the Camp Director.
I have read and agree to the terms above.
Volunteer References
Reference #1 (other than pastor or relative)
*
Reference #1 Phone Number
*
Reference #2 (other than pastor or relative)
*
Reference #2 Phone Number
*
Pastoral Signature Form
*
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Download Pastor Approval Form
here
.
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