Camp 33 Application Form Area of Interest I would like to be a Camp 33 Peer CounselorI would like to be a Camp Parent or Jeep Dad Personal Information: Please attach a recent photo (REQUIRED) Name Address City.St.Zip Mobile Email Occupation D.O.B. Communication EmailFacebookPhone CallTexting Using email is required for our team. Do you use email? YesNo Social Media FacebookInstagramSnapchatOther Using facebook is required for our team. Are you on Facebook? YesNo Family YesNo Children YesNo Emergency Contact Information #1 Relationship Name Address City, Sate, and Zip Home Phone Mobile Phone Emergency Contact Information #2 Relationship Name Address City, Sate, and Zip Home Phone Mobile Phone References (No family members please) *Email addresses are required, let them know to expect an email or call. Reference 1 Relationship Name Address City, Sate, and Zip Home Phone Mobile Phone Email Reference 2 Relationship Name Address City, Sate, and Zip Home Phone Mobile Phone Email Reference 3 Relationship Name Address City, Sate, and Zip Home Phone Mobile Phone Email Personal & Spiritual Information (Please provide a brief statement, with dates, on the following experiences in your life.) Salvation Baptism Relationship Describe your relationship with Christ over the last year. (Victories, healings, struggles, devotions, answers to prayer, etc.) Why Camp 33 Brief explanation of why you want to join us. Other How did you hear about Engage to Go Ministries and/or Camp 33? Tell us about yourself. Likes, Hobbies, anything you want to share. Do you have any medical issues that would potentially be of concern? (asthma, diabetes, problems with walking and/or running, etc?) If yes, explain. Church & Service History What church do you currently attend? How long have you attended there? (list all churches from the past 5 years) In what, if any, ministries are you currently serving at your local church? What other areas of ministry have you served in? Accountability Are you willing to submit to a background check and pay for the process? (Cost is approximately $25) YesNo Are you willing to sign a “Hold Harmless” agreement regarding your personal safety at Camp 33? YesNo Have you ever used illegal drugs? YesNo If yes, how long ago? Other Homework Complete? I have gone thru the RaveOutreach.com website and understand the “Big Picture”. I am signed up for the emails, and I have joined the Facebook Group, “Until Heaven is Crowded” I also watched the Gospel Video on www.plurway.com YesNo Do you own a Jeep or Off-Road Vehicle? (not required) YesNo Have you ever been Off-Roading? YesNo If yes, how much? OnceA few timesA lot Do you have any experience repairing automobiles? YesNo Skill level (0 = none 10 = pro) 012345678910 Name Date Signature 1+6 = ?