Team Program NEW Member Application--Step 1 of 2

Please complete the following form for Step 1 of the Team Program Application Process.  All fields marked with an (*) are required.  Once the form is completed, press the "Submit" button at the bottom of the page.  If this form is not completed in full and not submitted, no information will be saved.  Thank you.
 

Encampment Name	*
Encampment Date	*
GENERAL INFORMATION
Applicant's First Name	*
Applicant's Last Name	*
Gender	*	Female Male
Birthdate	*	- - Choose One - - January February March April May June July August September October November December *- - Choose One - - 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 * - - Choose One - - 1993 1994 1995 1996 1997 1998
Age	*
High School Name	*
Current Grade	*	- - Choose One - - 9th 10th 11th
Graduation Year	*	- - Choose One - - 2015 2014 2013
Address	*
City	*
State	*	- - Choose One - - AL AK AZ AR CA CO CT DC DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY
Zip	*
Student's Home Phone Number	*
Student's Email	*
PARENT/GUARDIAN INFORMATION
Parent/Guardian Name (1)	*
Parent/Guardian Phone Number (1)	*
Parent/Guardian Name (2)	*
Parent/Guardian Phone Number (2)	*
Parent Email (for confirmation purposes)	*
WORK EXPERIENCE
Are you currently employed?	*	Yes No
If yes, please submit the following information:
Company Name
Supervisor's Name
Supervisor's Contact Phone Number
PERSONAL TESTIMONY
Past Camp Experience (please describe your previous experience with overnight or day camps, both as a camper and volunteer):	*
Describe your personal Christian experience (salvation and your personal commitment to Christ):	*
Why do you desire to serve at Indian Hills Camp?	*
Are you currently involved in a ministry with your church or another Christian organization?	*	Yes No
If so, with what ministry and to what extent?
Describe how God has been developing you in a specific area of your life in the past six months?	*
How do you think God feels about you?	*
Additional Comments
By typing my name below, I, the Team Program Applicant named above, certify that all statements given on this application are accurate and realize that falsification or misrepresentation of this or any other personal record may result in my dismissal from the Team Program.
Applicant's First Name	*
Applicant's Last Name	*
Applicant's Electronic Signature (please enter full name)	*
This section is to be completed by the Parent/Guardian of the applicant named above.
A SAFE COMMUNITY
Dear Parent/Guardian,
We know that the Team Program can be a very rewarding experience, and we appreciate your child's interest in applying. Due to the nature of IHC's Summer Camp Ministry with elementary age children, it is our highest priority to ensure the safety of our campers. Every summer we serve a wide variety of kids. For this reason, it is our policy to screen all applicants desiring to serve at IHC. Furthermore, because the Team Program is designed for extensive interaction between Team Program participants and our campers, we request your help in the screening process by completing the following questions. Please note that a "yes" answer to any of these questions will not automatically exclude your child from participation, as all applicants are reviewed on a case by case basis.
Has your child at any time ever:
Engaged in or been accused of any act of violence, neglect, abuse, or molestation of any child or adult?	*	No Yes
Engaged in or been accused of any act of drug or alcohol abuse?	*	No Yes
As far as you are aware:
Is there any circumstance or pattern in the life of your child which would make it inappropriate for him or her to serve with children or which would compromise the integrity of Indian Hills Camp?	*	No Yes
If the answer to any of these questions is "Yes", please explain in detail.
By typing my name below, I, the Parent/Guardian of the Team Program Applicant named above, certify that all statements given on this application are accurate and realize that falsification or misrepresentation of this or any other personal record may result in my child's dismissal from the Team Program.
Parent/Guardian First Name	*
Parent/Guardian Last Name	*
Parent/Guardian Electronic Signature (please enter full name)	*
Security Code	*
Thank you for completing Step 1 of the Team Program Summer 2012 Application Process. An application successfully submitted will redirect you to a thank you page on the Indian Hills Camp website. If you are not redirected to a thank you page, your form has not been successfully submitted. Please ensure that all fields are completely and correctly filled out if not redirected. After submitting this form you will receive an e-mail at the Parent Address provided above. Open the e-mail and follow the directions in order to complete the Application Process.