2018 Application for Summer Service Team

2018 APPLICATION FOR SUMMER SERVICE TEAM

Hartman Center Milroy, PA 17063

Date:

Name ______

Address ______

______Zip ______

Home Phone ______Cell phone

E-Mail______

Birth Date ______Age ______

Social Security No. ______

High School ______Yr. Graduated ______

College ______Yr. Graduated ______

Address while at School______

______Zip

Major______

Home Church ______Pastor

Church Address ______

______Zip ______

Church Phone ______

Church Activities ______

______

______

Camp Experience:

As Camper _ ___ No.of Seasons ____ As Counselor _____ No. Seasons _____

Where? ______

Have you attended CIT camp at Hartman centerif so when

Have you attended a similar counselor trainingIf yes when and where

Do you have a valid driver’s license?

SKILLS CHECK LIST

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Name

Please indicate with an check (X)if you have some experience or ability in the skill listed. If you have more than average experience, please indicate by using a double check (XX)

Handicrafts

Painting or sketchingNature Crafts

PhotographyWeaving

WoodcraftsBasketry

Ceramics-pottery

Other

Music

SingingLead Group Singing

GuitarPiano

Dramatics

Other

Nature

What contributions can you make to this ministry as a Summer Service Team Member?

List three strengths you would bring as a Summer Service Team Member:

______

What is the significance of church camping for you?

List hobbies, skills, interests, etc., which will help you as a Summer Service Team Member::

References (please give names and complete addresses, including zip codes, phone

numbers)

1. ______

2. ______

3. ______

Signature______Date______

Return this application to:Pastor Patty Dodds

1175 West Fourth St

Lock Haven PA 17745

SKILLS CHECK SHEET

Name______Phone______

Address______

Please indicate by means of a check (X) if you have some experience or ability in the skill listed. If you have more than average experience, indicate it by using a double check (XX).

_____CookingHandicrafts

_____planning, preparing meals_____painting, or sketching

_____photography_____nature crafts

_____woodcraft

_____carpentry_____weaving

_____plumbing_____basketry

_____electrical work_____ceramics-pottery

_____landscaping_____sewing

_____painting (walls, etc.)

_____masonryNature_____laundering _____nature lore

_____trees

Music_____flowers

_____singing_____birds

_____lead group singing_____animals, tracking_____piano _____stars, astronomy

_____guitar_____other______

_____dramatics

_____puppetrySports

_____basketballOutdoor Skills _____volleyball

_____back-packing_____soccer

_____fire building_____leading recreation

_____canoeing ` _____(other)______

_____orienteering_____(other)______(other)______(other)______

Scouting Experience: Boy Scout____ Rank______Girl Scout____ Rank______

Certifications:

_____Lifesaving Certificate______(date)RedCross?YMCA? BSA?___

_____BSA Aquatic Instructor Certificate

_____Emergency Medical Technician

_____Red Cross First Aid Training

_____Red Cross CPR Certificate______(date)

_____Archery Certification

_____Ropes Course Certification

_____Boundary Training

_____Driver’s License _____Car _____Truck _____Bus

Please list below any additional skills and talents you have to offer the camp program on the back of this form: