Nehemiah 2017 Application
Camp BaYouCa
Please fill out and return with a $100.00 deposit by June 1st
Camp BaYouCa, 100 Camp Spaulding Rd. Smithville Flats, NY 13841
Application is processed after application and 2 reference forms are received at BaYouCa
I. GENERAL INFORMATION Today’s date______
Name______
Home Address______
City______State______Zip______
Phone (_____) ______Cell Phone______
Email address______Shirt Size: S M L XL XXL
Date of Birth______Age______
I first learned of Bayouca through:______
What attracted you most to Bayouca?______
What years have you attended Bayouca?______
Parents Information: Married Single Divorced/Separated
Parent 1 Name ______Parent 2 Name______
Parent 1 Address ______
Parent 1 City, State, Zip ______
Parent 1 Home Phone ______Parent 1 Cell ______
Parent 1 E-Mail ______Parent 2 Cell ______
Session Dates for Summer 2017
Monday, July 3 – Friday July, 7 and Sunday, July 9 – Friday, July 14
8:30 am -- 7:00 pm 7:30 pm --- 7:00 pm
II. EDUCATION
What grade are you now in?______
Your Present Grade Point Average______
School Activities :______
III. EMPLOYMENT
List most recent employment first
Name and address of company or person/ Position/ Date/Reason left
______
List any area of work or life in which you feel you have some skill ______
LEADERSHIP EXPERIENCE
List experiences in which you have led in order to make a positive difference in someone or some group’s life:
______
IV. PERSONAL HISTORY
Father’s Occupation______
Mother’s Occupation______
How would you describe your relationship with your parents? ______
V. CHRISTIAN EXPERIENCE
Where do you go to church? ______
How often do you attend this church? ______
On a separate sheet of paper please answer the following:
What do you believe is necessary for salvation?
How would you describe your relationship with God?
What experiences have contributed to your spiritual growth?
How do you think you can contribute to the community of Camp BaYouCa?
What has been the most meaningful thing that happened to you during your time at BaYouCa?
(if applicable)
What specifically do you want to accomplish in your life through the Leadership Training ministry at BaYouCa? List 3 goals.
References
1. Please give the reference forms to your youth pastor/pastor and a teacher.
2. Please instruct your references to send it to Dave Coy at:
Camp BaYouCa
100 Camp Spaulding Rd.
Smithville Flats, NY 13841
3. Applications will not be processed until at least two references have been received.
Pastor______Phone______
Address______
City______State______Zip______
Teacher Name______Phone______
Address______
City______State______Zip______
The cost for the leadership training ministry is $325. A $100 non-refundable deposit must accompany the application.
Space is limited. High School students (9th – 12th) who have a desire to lead and grow are eligible to apply. Selection of applicants will be based upon timeliness of application return, and clarity and vision communicated in application. Upperclassmen will get priority in filling spots if applications are received on the same day.
VERIFICATION
As consideration for the above-named supervisor’s agreement to consider my application, I hereby authorize him/her to engage in background checks regarding any and all statements I have made on this application and, further, to obtain any other information regarding my previous employment, my veracity, my skills and or/ abilities which the above named supervisor may deem relevant.
I authorize any references or churches listed in this application to give you any information (including opinions) that he/she may have regarding my aptitude for pre-adolescent or youth work. In consideration of the receipt and evaluation of this application by Camp Bayouca, I hereby release any individual, church, youth organization, charity, reference or any other person or organization, including record custodians, both collectively and individually, from any and all liability for damages of whatever kind of nature which may at any time result to me, my heirs, or family, on account of compliance or any attempts to comply, with this authorization. I waive any rights I may have to inspect any information provided about me by any person or organization identified by me in this application.
I also understand that leadership activities such as service projects on Camp Bayouca’s grounds and camp activities such as initiative problems, ropes course, hiking, canoeing, etc. have inherent risk that could involve injury and require medical treatment. I understand that there will be travel off of Camp Bayouca property for leadership trips and give permission for my camper to travel off site with Bayouca leadership in Camp Bayouca authorized vehicles. I accept this risk and agree to clarify with Camp Bayouca points I am unsure of regarding the specifics of this training. I agree to hold harmless Camp Bayouca and its agents and employees.
Should this application be accepted, I agree to be bound by the polices of Camp Bayouca and to refrain from unscriptural conduct in the performance of my services on behalf of the organization.
I further state that I HAVE CAREFULLY READ THE FOREGOING RELEASE AND KNOW THE CONTENTS THEREOF AND SIGN THIS RELEASE AS MY OWN FREE ACT.
Applicant’s Signature______Date:______
Applicant’s Parent Signature______