Team Program 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	*
Are you new to the Team Program or returning?	*	New Returning
If returning, what is your camp name?
Gender	*	Female Male
Birth Date	*	- - 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 *
Age	*
Shirt Size	*
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 Cell Phone Number	*
Student's Email	*
High School Name	*
Current Grade	*	- - Choose One - - 9th 10th 11th
Graduation Year	*
Church Name	*
Pastor	*
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
RECOMMENDATIONS
Please provide the name and contact information for a youth pastor, small group leader or mentor. In order to efficiently move through the administration process, Indian Hills Camp will contact your reference listed below to submit a recommendation form on your behalf. A recommendation is required for acceptance into the program.
Reference Name	*
Reference Phone Number	*
Reference Email	*
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):	*
Describe your relationship with God at this present time.	*
Why do you desire to serve at Indian Hills Camp?	*
How do you think God sees you?	*
Returning Team: If you are not currently serving in a ministry, you must find a ministry and be serving for at least one month before your application will be accepted and processed.
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?
How long have you been serving in this ministry?
What is the name of your supervisor in this ministry?
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.
Read these commitments carefully and initial in the box next to each statement. By typing your initials, you the parent/guardian of the applicant, are committing to these statements.
In the event of acceptance, my child would consider it a privilege to undertake any responsibility given to them by the IHC Administration.	*
The IHC Training Session dates are from June 18 to 22, 2017.	*
In the event of acceptance, my child is able to attend the IHC Training Session from June 18 to 22, 2017.	*	Yes No
List all conflicting dates during the IHC Training Session and the reason your child will not be present.	*
The IHC contract dates are from June 18 to July 9, 2017.	*
If accepted, my child is available and will commit themselves to fulfill the contract dates, starting June 18, 2017, and ending July 9, 2017.	*	Yes No
List all conflicting contract dates and the reason your child will not be present.	*
I authorize all previous employers to furnish records, including the reasons for leaving, and all information that they may have concerning my child. I hereby release Shiloah Springs Bible Retreat, Inc. (Indian Hills Camp) from all liability or damage arising there from.	*
If accepted, my child will commit to filling out and turning in any required paper work needed on time and when requested.	*
My child is interested in participating at Indian Hills Camp this summer. My child understands that in order to participate he/she must raise $675.00.	*
This section is to be completed by the Parent/Guardian of the applicant.
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 2017 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. We will send an email to the parent email address provided on the application shortly with instructions on completing the application process.