2014 Adult Camp Volunteer Application
Desert Southwest Conference
The United Methodist Church
Note: All volunteers are now required to undergo an annual background check. Please be sure to fill out the form on page 3. Volunteers must be at least 4 years older than the oldest camper at camp and attend camp training. Not all volunteers who apply may be accepted.
Name: ______Phone: ______
Mailing Address: ______
City: ______State: ______Zip Code: ______
Birthdate (month/day/year):______Gender: ______
Ethnicity (optional):______E-Mail: ______
Church you attend:______Are you a Member? ______
Have you ever been convicted of a felony? ______
Have you ever been charged or convicted of child or sexual abuse? ______
Are you involved in any pending litigation involving a felony or child abuse? ______
PLEASE CHECK CAMP PROGRAM(S) FOR WHICH YOU WOULD LIKE TO BE CONSIDERED
MINGUS MOUNTAIN POTOSI PINES SOUTH
_____ Winter Camp _____ Winter Camp (Jr/Sr) (See Mingus Mountain Camps)
January 18-20 January 18-20
_____ Explorers Camp _____ Winter Camp (Elem)
June 2 -7 February 15-17
_____ Camp Discovery _____ Elementary 1 Camp (Greatest Show)
June 9 – 14 June 23-27
_____ Super Camp _____ Jr. High Camp (Get Real)
June 16 – 21 July 7-11
_____ Senior High Camp _____ Elementary 2 Camp (Space Camp)
June 30 – July 5 July 14-18
_____ Odyssey Camp _____ Sr. High Camp (Finding Your True Self)
July 7 – 12 July 21-25
_____ Elementary 3 Camp (Get a Clue)
August 4-8
Please circle position(s) of interest:
___ Dean ___ Cabin Leader ___ Program Staff
___ Nurse ___ Cabin Leader in Training Other ______
Please list any previous camping experiences you have had:
______
______
List any experiences or training you’ve had in working with the age groups indicated:
______
Please list any professional experience that you would bring to a camp staff:
______
What expectations do you have for a camping experience?
______
______
Please share a little of your faith story/journey:
______
______
______
______
Please give pages 1 & 2 of the completed application to your pastor for a written recommendation. The pastor will return this form to the United Methodist Center. Please fill out page 3 and return directly to us.
Pastor’s Recommendation
Please tell us why this person would or wouldn’t make a good leader and role model for children at camp…
______
______
______
______
______
Signature: ______
Please return to: Camping Office, United Methodist Center, 1550 E Meadowbrook, Phoenix, AZ 85014-4040
(602) 266-6956 or (800) 229-8622
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Desert Southwest Conference
The United Methodist Church
BACKGROUND INVESTIGATION CONSENT
I, ______, hereby authorize The Desert Southwest Conference of the United Methodist Church and/or its agents to make an independent investigation of my background, references, character, past employment, education, criminal or police records, including those maintained by both public and private organizations and all public records for the purpose of confirming the information contained on my Volunteer Application and/or obtaining other information which may be material to my qualifications for volunteering now and, if applicable, during the tenure of my association with The Desert Southwest Conference.
I release The Desert Southwest Conference and/or its agents and any person or entity, which provides information pursuant to this authorization, from any and all liabilities, claims or lawsuits in regards to the information obtained from any and all of the above referenced sources used.
The following is my true and complete legal name and all information is true and correct to the best of my knowledge:
______
Full Name (Printed)
______
Maiden Name or Other Names Used
______
Present Address How Long?
______
City/State Zip
______
Former Address How Long?
______
City/State Zip
______
Date of Birth Social Security Number Driver's License Number State of License
______
Signature Date
Note: The Desert Southwest Conference will keep all reports, whether oral or written, strictly confidential and, except as required by law, reveal information from reports only to the volunteer or a person whose duty requires him or her to participate in the decision for the transaction for which the report was ordered.
Please return to: Camping Office, Desert Southwest Conference, 1550 E. Meadowbrook, Phoenix, AZ 85014
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