Volunteer Application Form - Disciples Center at Tawakoni

Volunteer Application

Note: The policy of the Christian Church in Kansas (Disciples of Christ), Inc., states: “Counselors must be at least twenty (20) years old, or have completed two (2) years of college…” Exceptions are made for Counselors in Training, who are at least 16 years old.

An application needs to be completed and signed each year a person wishes to serve in a camp. Placement on a camp staff is not guaranteed by submitting this form. Those seeking a summer intern position should complete the Summer Leadership Intern Application
Contact Information
Name*
First Middle Last
Birth Name or Alias*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
How long have you lived at this address?*
Prior Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Primary Phone*
This phone is a*
- Mobile
- Home
- Office
Secondary Phone
This phone is a
- Mobile
- Home
- Office
Email*
Date of Birth*
MM slash DD slash YYYY
Place of Birth*
City, State OR Foreign Country
T-Shirt Size (Adult Sizes)*
- S
- M
- L
- XL
- XXL
Describe any health and or diet issues particularly ones that may prevent you from participating in camp activities*
Church Information and Participation

The Camp and Conference Ministry of the Christian Church in Kansas seeks leaders who model mature faith and who appropriately represent the Christian Church (DOC) tradition.
Church Membership (Church and Town)*
How long have you been a member?*
Please check all that apply*
- I attend worship
- I lead/teach a youth fellowship, Sunday School class, or Bible study at my local church
- I serve in other ways in my local church (explain below)
- I participate in Bible Study or Prayer group
- I display service to others (explain below)
How often do you attend worship?
- Frequently
- Some
- Seldom
Name of class/group you lead/teach
What other ways do you serve in your local church?
How often do you participate in Bible Study or Prayer group
- Frequently
- Some
- Seldom
How do you display service to others?
Other ways I display mature faith and/or exercise my Christian faith
Personal Disclosure Statement
in accordance with the Child Protection Policies of the Christian Church in Kansas (If any question below is answered yes, please explain.)
Have you ever been charged or convicted of a felony?*
- No
- Yes
Have you ever been charged with or convicted of any crime against children or other persons?*
- No
- Yes
Is there any other fact or circumstance in your background that should prevent you from being entrusted with the supervision, guidance and care of children or youth?*
- No
- Yes
If yes, please explain
Volunteer Position and Availability
I am volunteering for:*
- Camp Director
- Camp Nurse
- Camp Chaplain
- Camp Counselor
- Camp Counselor in Training
- Camp Maintenance
I wish to serve for the following (select all that apply)*
- Discovery (Grades K-1)
- Primary (Grades 2-3)
- Junior (Grades 4-5)
- Chi Rho (Grades 6-7)
- Pre-High (8th Grade)
- CYF Conference (Grades 9-12)
- Other
If other, please specify
I am available (check one or more)*
- June
- July
- Either
- Other
If other, please explain
Often times we are looking for people with specific talents to enhance the camp experience. Describe any certifications, talents, hobbies, and or skills you bring to the camp program (i.e. music, arts & crafts)*
References

Please list three persons who are familiar with your character as it relates to working with children/youth. Beginning 1999, Volunteer Application Form References will be kept on file and considered valid for a period of three (3) years. Include your pastor/youth pastor as one, please.
Pastor/Youth Pastor Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Primary Phone*
This phone is a*
- Mobile
- Home
- Office
Secondary Phone
This phone is a
- Mobile
- Home
- Office
Email
Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Primary Phone*
This phone is a*
- Mobile
- Home
- Office
Secondary Phone
This is a
- Mobile
- Home
- Office
Email*
Relationship*
Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Primary Phone*
This phone is a*
- Mobile
- Home
- Office
Secondary Phone
This phone is a
- Mobile
- Home
- Office
Email*
Relationship*
General Release and Signatures
I, the undersigned, certify that the information contained in this application is correct to the best of my knowledge. I understand that the Christian Church in Kansas (CCK), through the Camp & Conference Ministry, will be contacting persons or organizations named in this application to confirm my abilities and character appropriate for leadership in Church Camping programs.

I authorize any reference listed in this application to give any information they may have regarding my character and fitness for working around children, youth or others in the church. I release all such references from liability for any damage that may result from furnishing such evaluations; and, I waive my right to inspect references provided on my behalf.

I understand that I am expected to be an appropriate moral role-model for youth, and I believe that I am capable of serving in that capacity. Further, I agree to participate in any training event(s) pertaining to my service as a member of a Camp Staff sponsored by the Camp & Conference Ministry, CCK.

Should my application be accepted, I agree to abide by the best ethical behavior becoming of a ministry leader and will abide by the policies pertaining to the CCK Outdoor Ministries program, and to the Ministerial Code of Ethics.
Signature*
Date*
MM slash DD slash YYYY
Comments
This field is for validation purposes and should be left unchanged.

Volunteer Application

Contact Information

Church Information and Participation

Personal Disclosure Statement

Volunteer Position and Availability

References

General Release and Signatures

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