TEEN STAFF APPLICATION

TEEN STAFF APPLICATION

Dear Church Contact Person, Enclosed are Junior Camp Teen Staff forms. Please note: These forms are revised. All forms and fees must be gathered and sent from your church office with a church check or church/personal credit card information. No personal checks are accepted. Mail forms and direct questions to the following contacts: Rev Chris Jansen (staff related) 555 South Madison St. Waupun WI 53963 widistrictcamp@gmail.com 920-527-9101 Bethany Welch (camper related) PO Box 903 Marinette, WI 54143 bethany_m_welch@yahoo.com 715-735-6378 General Information: Camp dates: Monday, June 18 (1:00 pm) to Friday, June 22 (2:00 pm) Recreation: All campers will receive recreation T-shirts and participate in sports and field games. Lice Check: The State of Wisconsin Health Department requires that every child and staff member be checked for head lice before lodging accommodation are assigned. We recommend that a qualified person check your campers/staff prior to camp; however, Junior Camp staff must perform the lice check when campers/staff arrive. Guidelines & Dress Code: Please ask all campers, parents, and staff to read the guidelines and dress code on the 2 nd page of the application. These will be adhered to in all circumstances. DVDs & Picture Packets: Drama DVDs and picture packets (dorm, class, team) are available for $5 each. Please check the ( QTY ) on the registration forms if ordering. Include the additional fees with camper fees. Cell phones & electronics policy: Please make all campers, parents, and staff members aware of our cell phone/electronics policy written on the 2 nd page of the registration/application forms. Signatures: Please verify that all signatures are on the forms before mailing. Camper Information: Camper fees: Health forms: Registration Time: Signatures: $175.00 Camper Registration Fee $15.00 - Late fee if postmarked after April 30. $15.00 - Cancellation Fee Require parent & Physician/Registered Nurse Signatures. Forms may not be signed by an LPN. Health forms may be brought on the day of camp without incurring a late fee. Campers should arrive on Monday 1:00 to 3:00 pm, those arriving early will wait until 1:00PM. Registration forms require parent, camper, & pastor signatures. Staff Information Registration Deadline April 30 th, 2018 Adult and teen staff registration deadline has been moved ahead in order to confirm staffing assignments in advance of camp. Teen Staff Fee: $30.00 Age Requirement: No one under 16 allowed on staff unless parent is working at camp. Digital Photo: Health Forms: T-Shirts: Staff Registration: All staff must submit a photo with their paperwork or via email to widistrictcamp@gmail.com Returning staff who submitted a picture last year in 2017 are not required to resubmit a picture. Health forms are required for everyone on the campground (babies & toddlers included), and require parent & Physician/Registered Nurse signatures. T-Shirts may be purchased for $15. Please check the ( QTY ) on Registration forms if ordering. Include the size & additional fees. Monday, 9:00 am to 11:00 am. Staff members may not arrive at camp prior to that time without approval of the Sunday School Director. Teen Staff Applicants Ages 13-17 Need To Submit: Signed Teen Staff Application Signed Teen Staff Health Form Emailed Photo Thank you for helping us prepare efficiently prior to camp. We appreciate your effort and are available for any questions.

TEEN STAFF APPLICATION ($30 Fee Required) Wisconsin District Jr Camp 2018 Monday, June 18 at 1:00 pm - Friday, June 22 at 2:00 pm New Staff Registration Deadline April 30, 2018 Mail to: Rev Chris Jansen (staff related) 555 South Madison St. Waupun WI 53963 widistrictcamp@gmail.com Personal Information Please check if this is your first time applying as staff for Jr Camp First Name: Last Name: Gender: Male Female Address: City: State/Zip: Email: Birthdate: / / Age: Phone: Parent/Guardian Name: Parent/Guardian Phone: Contact Method: Phone Email Pastor: Home Church: Lodging: Dorm I have my own camper or tent Position Requests (not guaranteed) Preferences will be reviewed and assigned by administration. You will be informed of your assignment prior to the start of camp. Primary Positions (must choose one): Food Service Recreation Teaching Drama Sanitation Counselor Secondary Positions (must choose two): Food Service Recreation Teaching Drama Sanitation Counselor Product Orders I have attached the following: Product Name Qty Price Total Teen Staff Health Form Teen Staff Fee (Required) 1 $30.00 $30.00 DVD $5.00 Photographs $5.00 Camp Shirt (circle size below) $15.00 I Email A Photo widistrictcamp@gmail.com I Emailed Photo In 2017 Youth: S M L XL Adult: S M L XL 2X 3X Total Enclosed (credit/church check): I have read the camp rules & dress code guidelines. I agree to abide by these & will conduct myself in a manner pleasing to God. I will obey all camp rules. I will respect all those in authority & work in harmony with other staff. Applicant's Signature: Date: The above mentioned child has my approval to apply as a staffer at Wisconsin District Junior Camp 2018. Parent/Guardian Signature: Date: The above named people are associated with our church. I feel they qualify for the position(s) requested and have my recommendation to apply. Pastor's Signature: Date:

Teen Staff Application - Wisconsin District Jr Camp - Health Screening Section 1: Staff Member Last Name First Middle Address City, State, Zip Home Church Insurance Carrier Date of Birth Home Phone Pastor Insurance Carrier Phone Insurance Policy # Section 2: Parent or Guardian/Emergency Contact (if staff member is under 18) Last Name First Name Relationship Home Phone Work Phone Section 3: Health Information Is staff applicant currently taking any medications? yes no If yes, please list medications, dosage and reason for taking. Any recent exposure to communicable diseases? yes no If yes, please explain Description of any physical condition requiring special attention: Any specific activities to be restricted? Date of last Tetanus shot: Are immunizations current? yes no If no, please explain: REQUIRED Does the camp nurse have permission to give staff: Tylenol: yes no Anti- histamine: yes no Aspirin yes no Ibuprofen: yes no Decongestant: yes no This health history is correct so far as I know, and is up to date as of the last 90 days. The person herein described has permission to engage in all prescribed camp activities except as noted. Emergency Authorization: I hereby give permission to the medical personnel selected by the camp officials to order x-rays, routine tests and treatment for me or my child, as in the event I cannot be reached in an emergency. I hereby give permission to the physician selected by the camp director to hospitalize, secure proper treatment for, and to order injection and/or anesthesia and/or surgery for me or my child as named above. I hereby give permission to transport me or my child for medical assistance. I hereby give permission to the WI District UPCI Camps to use photos, likenesses, and images of me for marketing and publicity purposes. This form may be photocopied for use at camp. I understand that I am responsible for payment of all medical treatments received from non-camp sources. I also give permission for the camp medical staff to administer over-the-counter medications to my child, that the physician has approved on page 2 of this form. I also give permission for my child to participate in all camp activities. Staff Applicant Signature Date (If Under 18) Parent/Legal Guardian Signature Relationship to Staff Applicant Date Section 4: Medical Screening - By Certified Medical Personnel I have screened the above applicant and approve of his/her participation in the physical and out-of-doors activities of the camp program. Please list any restrictions or concerns Signature Phone Title Date

Staff Application Guidelines To apply as camp staff, submit the following with appropriate signatures: Application (signed by you and your pastor), Health form (signed by a Doctor or RN), Background questionnaire and Notarized authorization, Photo for ID Badge and any fees (teen staff: $30; if ordered, $5 per drama DVD/picture pack or $15 per camp shirt). The camp nurse at a cost of $30 will screen unsigned health forms. Submit these through your church contact person/office. Applications received after APRIL 30, 2018 or incomplete applications may not be considered. Please note that we only accept church checks and church or personal credit cards. Send staff applications/fees to: Rev Chris Jansen 555 South Madison St. Waupun WI 53963 *************************************** Applicants will receive an acceptance email prior to camp indicating the position and responsibilities they will have during camp. Teen applicants under age 16 will not be accepted unless the parent is also on staff. Teens between ages 13-16 will be assigned lodging and tasks with their parent. *************************************** The State of Wisconsin Health Department requires that each person be checked for head lice before lodging accommodations can be assigned. It is suggested that a qualified person check each person for head lice prior to camp; however, Junior Camp staff MUST perform a lice check when staff/campers arrive. *************************************** Staff registration is from 9-11 a.m. on Monday morning. Only those staff members with written permission may be on the campground before then. Staff members need to bring: - Soap, toothbrush/paste, towels/washcloths, warm bedding/pillow - Clothing for the daytime activities, evening worship service, and sleeping - Warm sweater or jacket - Mosquito repellant and/or sunscreen - Any items received or prepared for position (manuals, supplies, etc.) Spending money for soda machines or concessions. Please read manuals and paperwork thoroughly. All accepted staff members will receive these prior to camp. Please read the attached dress code and prohibited items. By signing the camp applications, campers and staff agree to follow these guidelines. Wisconsin District Junior Camp Dress Code & Guidelines 1. Junior Camp is a closed campus; no visitors are allowed. Pastors and spouses may visit, but must register at office. 2. If unauthorized items are brought, security will confiscate the item with no guarantee of a safe return. Items not allowed: knives (including pocketknives), slingshots, water guns, or any kind of weapon (real or imitation); unauthorized walkie-talkies; heaters, or air conditioners (due to the power supply required); For those under age 18 or anyone staying in camper dorms: tape or CD players, IPod, MP3 s etc.; computers, musical instruments, electronics, handheld games, are not permitted. 3. Cell phone and electronics policy: No one under 18 may use their cell phones (calling or texting) during Junior Camp. Adults, age 18 and older, may use their cell phones for calls or texting when they are not with campers. Absolutely no digital pictures of campers may be taken in dorms or bathrooms and no pictures may be posted to any internet site. The Wisconsin District Children s Ministries will take official pictures for the picture packets, our files, and for promotional use. Please understand this policy is to protect the minors in our care. 4. Please follow the dress code below. It will be adhered to even if it differs from your personal opinion. Security will ask you to change if clothing violates it. Dress Code for Girls and Ladies Daytime/ Evening Service: Skirts and shirts or dresses with hemlines below the knee must be worn at all times. Recreation: Culottes which look like a skirt may be worn. These must have a skirt panel and hemline below the knee. Sleepwear: Full length, modest bathrobes must be worn when visiting the restroom. Not permitted: Sleeveless outfits (unless worn under a sweater or jacket) Shorts, slacks, make-up, and jewelry Clothes with unacceptable slogans, symbols, or pictures on bust line or buttocks areas Skirts/dresses with slits above the knee; tight skirts or dresses Tight or too short t-shirts, cap sleeve t-shirts, or immodest necklines Water Fight Dress Code: Camp sports shirt or dark colored, loose fitting shirt and nonclinging, dark colored skirt, culottes, or jumper Dress Code for Boys and Men Daytime/ Evening Service: Pants and shirt must be worn at all times. All shirts must have sleeves. All pants must be full-length. Hair must be cut so that it is off the collar and ears. Recreation: Full-length modest recreation pants such as jeans, sweat, or athletic pants Sleepwear: Full length, modest bathrobes or sweat suits must be worn to the restroom. Not permitted: Sleeveless shirts (only T-shirts worn under a shirt) Shorts of any length Make-up and jewelry Clothes with unacceptable slogans, symbols, or pictures on chest or buttocks areas Tight or immodest pants; Tight or too short t-shirts and muscle shirts Water Fight Dress Code: Camp sports shirt or dark colored, loose fitting shirt and nonclinging, dark colored pants

Wisconsin District Junior Camp Credit Card Form (OPTIONAL) To pay by credit card for staff fees, please fill out all information and send with staff registration forms to: Wisconsin District Children's Ministries 555 South Madison St. Waupun WI 53963 I agree to pay the following fees. Please charge my credit card. # of camper fees: X $175 = $ # of DVD s ordered: X $5 = $ # of Picture ordered: X $5 = $ Late Fees (if applicable) X $15 = $ Health Fees (if applicable) X $30 = $ # of teen staff fees: X $30 = $ # of staff shirts ordered: X $15 = $ Total to charge: $ Card Type ( ) Mastercard ( ) Visa Credit Card # 3-Digit CVV Expiration Date: Month / Year Name On Card (PRINTED) Billing Street Address (No PO Box's): City: State Zip: Cardholders Signature: