First Name Last Name Date of Birth

Address Town/City Zip Code

Phone Number e-mail

Occupation and Employer

Do you have any certifications (such as CPR, First Aid or Lifeguard)? Yes No

If yes, what are you certified in? Expiration of Certification?

Ministry
Which week(s) do you desire to serve?

I want to serve the following weeks.
Ages 7-9 June 22nd - 27th
Day Camp (Ages 5-8) June 29th - July 4th
Ages 10-12 #1 July 6th - 11th
Ages 13-14 July 13th - 18th
Ages 10-12 #2 July 20th - July 25th
Ages 15-17 July 27th - August 1st
Ages 10-12 #3 August 3rd - 8th
All 7 Weeks June 2nd - August 8th

In what capacity do you desire to serve? (Please check all that apply to your abilities.)
Cabin Counselor (minimum age of 18)
Assistant Counselor (minimum age of 16 except during Day camp)
Kitchen Worker
Head Cook
Worship Leader
Life Guard
Nurse
Program Staff / Maintenance work

Camp Experience: As a camper (weeks) As a staff member (weeks)

Why would you like to serve as a volunteer at River of Life?

Personal Spiritual Development

Please give a brief account of your testimony.

Church that you presently attend

Pastor’s name Pastor's phone number

Pastor's e-mail Pastor's address

Do you have a regular time in the Word and prayer? Yes No
What experience do you have in Youth Ministry?

References

Please give us the names, addresses and phone numbers of three references that can attest to your character and
spiritual growth.
1)

2)

3)

Submit