Date Rec’d _____________
Background Check’d____
Name________________________________________________ Male_____ Female_______
Home Address: _______________________________________________________________
(Street or PO Box)
City: ___________________________________ State: _________ Zip: __________________
Home Phone: (______)__________________ Work Phone: (_____)______________________
Pager:____________________________________ Email: ____________________________
Place of Employment: __________________________________________________________
Address of Employer:___________________________________________________________
Active member of what church____________________________________________________
Which are you most fluent: ASL____ PSE____ SEE____ Oral_____ Cued Speech _____
Camp T-Shirt Form Please check your t-shirt size.
What is your favorite Bible verse? _______________________ Why? ___________________
__________________________________________________________________________
In ten words or less how would you explain “salvation” or “saved” to a camper? ___________
__________________________________________________________________________
__________________________________________________________________________
Explain how you show Jesus in your life to other people? ______________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
EMERGENCY CONTACT INFORMATION
In case of emergency call: _______________________________________________________
HOME PHONE: (_____)__________________ CELL PHONE: (______)____________________
Address: ________________________________________ Relationship: _________________
Interest Inventory
Send a copy of your insurance card, registration, interest inventory and health form to:
Linda Whiggam
8190 Grant Colonial Dr.
St. Louis, MO 63123
All financial contributions should be made out and sent to:
Friendship Baptist Chapel of the Deaf/Deaf Youth Camp
9125 Manchester Rd.
St. Louis, MO 63144
(In the MEMO area of your check please put “DYC” thank you)
I have interviewed this person and to the best of my knowledge, the facts listed in this application are true
and I am recommending this person for MO-OK Deaf Youth Camp.
Pastor’s Signature ______________________________ Date_________________
DEADLINE for receiving application is May 20, 2009
Updated 8/15/08
Return to DYC Staff
Background Check’d____
Name________________________________________________ Male_____ Female_______
Home Address: _______________________________________________________________
(Street or PO Box)
City: ___________________________________ State: _________ Zip: __________________
Home Phone: (______)__________________ Work Phone: (_____)______________________
Pager:____________________________________ Email: ____________________________
Place of Employment: __________________________________________________________
Address of Employer:___________________________________________________________
Active member of what church____________________________________________________
Which are you most fluent: ASL____ PSE____ SEE____ Oral_____ Cued Speech _____
Camp T-Shirt Form Please check your t-shirt size.
What is your favorite Bible verse? _______________________ Why? ___________________
__________________________________________________________________________
In ten words or less how would you explain “salvation” or “saved” to a camper? ___________
__________________________________________________________________________
__________________________________________________________________________
Explain how you show Jesus in your life to other people? ______________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
EMERGENCY CONTACT INFORMATION
In case of emergency call: _______________________________________________________
HOME PHONE: (_____)__________________ CELL PHONE: (______)____________________
Address: ________________________________________ Relationship: _________________
Interest Inventory
Send a copy of your insurance card, registration, interest inventory and health form to:
Linda Whiggam
8190 Grant Colonial Dr.
St. Louis, MO 63123
All financial contributions should be made out and sent to:
Friendship Baptist Chapel of the Deaf/Deaf Youth Camp
9125 Manchester Rd.
St. Louis, MO 63144
(In the MEMO area of your check please put “DYC” thank you)
I have interviewed this person and to the best of my knowledge, the facts listed in this application are true
and I am recommending this person for MO-OK Deaf Youth Camp.
Pastor’s Signature ______________________________ Date_________________
DEADLINE for receiving application is May 20, 2009
Updated 8/15/08
Return to DYC Staff
| June 7 - 12 2009 |
|
What areas are you willing to serve? Please check Yes
or No in the areas you are interested. Thank you!
or No in the areas you are interested. Thank you!
|
|
|
|
|
Outdoor Activities Yes No
TEACHING YES NO
Staff Positions Yes No
Indoor Activities Yes No
Teacher Assistant Yes No
Permission to Photograph/Video
This year MO-OK Deaf Youth Camp will be producing a video of our week at camp. The video will be
used for camp purposes only. We need your permission to take pictures of you. There will not be any
names used in this video.
MO-OK Deaf Youth Camp has my permission to video/photograph me to be used for camp
purposes/promotion only.
_______________________________________ ______________________________
Staff Signature Date
PLEASE READ CAREFULLY AND SIGN
STAFF AUTHORIZATION:
I approve the application above and the conditions listed here and on the STAFF MEDICAL FORM. It is agreed
that MO-OK Deaf Youth Camp will not be held responsible for unforeseen accidents or illness while I am at camp. I
recognize there is an element of risk in activities I may participate in while staying at MO-OK Deaf Youth Camp. I
assume full responsibility for myself, for any accident or injury that may occur while staying at MO-OK Deaf Youth
Camp. I hereby release, indemnify, and hold harmless MO-OK Deaf Youth Camp, its agents and volunteers, from
and against any and all claims, liabilities, suits, actions, attorney’s fees, and including without limitation any act,
omission, or negligence of MO-OK Deaf Youth Camp, it’s agents and volunteers, which may arise from or in any
way be connected with my stay or participation in activities at MO-OK Deaf Youth camp.
I understand that I will be expected to comply with Campground guidelines and the MO-OK Deaf Youth Camp rules
and aims.
_________________________________________ ______________________
Signature Date
This year MO-OK Deaf Youth Camp will be producing a video of our week at camp. The video will be
used for camp purposes only. We need your permission to take pictures of you. There will not be any
names used in this video.
MO-OK Deaf Youth Camp has my permission to video/photograph me to be used for camp
purposes/promotion only.
_______________________________________ ______________________________
Staff Signature Date
PLEASE READ CAREFULLY AND SIGN
STAFF AUTHORIZATION:
I approve the application above and the conditions listed here and on the STAFF MEDICAL FORM. It is agreed
that MO-OK Deaf Youth Camp will not be held responsible for unforeseen accidents or illness while I am at camp. I
recognize there is an element of risk in activities I may participate in while staying at MO-OK Deaf Youth Camp. I
assume full responsibility for myself, for any accident or injury that may occur while staying at MO-OK Deaf Youth
Camp. I hereby release, indemnify, and hold harmless MO-OK Deaf Youth Camp, its agents and volunteers, from
and against any and all claims, liabilities, suits, actions, attorney’s fees, and including without limitation any act,
omission, or negligence of MO-OK Deaf Youth Camp, it’s agents and volunteers, which may arise from or in any
way be connected with my stay or participation in activities at MO-OK Deaf Youth camp.
I understand that I will be expected to comply with Campground guidelines and the MO-OK Deaf Youth Camp rules
and aims.
_________________________________________ ______________________
Signature Date