Bethel Community Church€¦  · Web viewEating Disorder (e.g Anorexia, Bulimia etc) Anxiety. Chronic Fatigue. Allergies. ADD/ADHD. ODD. Self Injury (e.g Cutting) Anger Management.

VOLUNTEER APPLICATION FORM

128 St. Vincent Street Barrie, ON L4M 3Y8 Tel: 705-722-5221 Fax: 705-722-5082 [email protected] with the Canada Revenue Agency

Registration No. 128793049RR0001

INTERN/VOLUNTEER APPLICATIONJOB INFORMATION

Position LocationDate Received:

Date

Interviewed:

Start Date:

Adult Volunteer Student Volunteer Mission Internship

Camp Promise@ Bethel128 St. Vincent StreetBarrie ON L4M 3Y8Contact: Tracy RobinsonCell: 705-726-9778Email: [email protected]

PERSONAL INFORMATION

Last Name First Name M.I

Street Address Apart/Unit City Postal Code

Home Phone Cell Phone Email

Health Card # Date of birth Church name (if applicable)

Current School/Workplace Grade level

EMPLOYMENT/VOLUNTEER HISTORY

Date Employer/Supervisor Job title/Volunteer position

REFERENCES

Full Name Relationship Phone Email

AVAILABLITY

What days are you available? What age group would you like to work with?

Children (ages 5-10)

Youth (ages 11-14)

Wednesday 3pm – 7pm

Thursday 3pm – 7pm

Saturdays - part day (relationship building)

Sundays (helping bring children to church at Bethel)

VOLUNTEER APPLICATION FORM

INTERN/VOLUNTEER APPLICATION

128 St. Vincent Street Barrie, ON L4M 3Y8 Tel: 705-722-5221 Fax: 705-722-5082 [email protected] with the Canada Revenue Agency

Registration No. 128793049RR0001

ADDITIONAL INFORMATIONPlease check all experience/qualifications you possess:

Please provide a brief narrative of your spiritual life story (if applicable):

Describe any experience you have in working with a team?

Describe your strengths/skills/talents that are applicable to working with children and youth?

Describe any weaknesses?

Describe briefly what you know about working with children/youth at risk?

Child/youth work Christian ministry Leadership Planning Working with non-profit organizations Arts and crafts

Community development First Aid/CPR Social Work Camp/club experience Musical abilities Sports OTHER

VOLUNTEER APPLICATION FORM

INTERN/VOLUNTEER APPLICATION

128 St. Vincent Street Barrie, ON L4M 3Y8 Tel: 705-722-5221 Fax: 705-722-5082 [email protected] with the Canada Revenue Agency

Registration No. 128793049RR0001

MEDICAL / HEALTHAt Camp Promise, providing a safe environment for our children and youth is paramount. As such, we endeavour to be as forthcoming as possible with the stresses a person can expect to experience in our environment. We also ask that applicants are upfront with Camp Promise about past or current struggles and/or medical conditions.Please be aware that, in some circumstances, further documentation may be required. Anything not disclosed that may affect the safety of teammates or children can be grounds for removal from the volunteer position.

Information provided in the following section is kept in strict confidence.

Do you have a history or past incidents of:

a. Emotional difficulties

b. Medical/physical conditions

Please check off any of the following conditions or experiences that have occurred or that you suspect may be true for you (even if it has not been medically diagnosed )

Condition/experience YES NO If yes please provide more information

Depression

Eating Disorder (e.g Anorexia, Bulimia etc)

Anxiety

Chronic Fatigue

Allergies

ADD/ADHD

ODD

Self Injury (e.g Cutting)

Anger Management

Abuse: Physical, Emotional, SexualAre you currently on any medication YES/NO (Please list with reason for use)

I certify that all answers provided in this form and during the interview are true and complete. I understand that providing false or misleading information, or the omitting of information, may be grounds for rejecting my application or, if hired, may result in dismissal.

Signature: Date: