Name
*
First Name
Last Name
Today's Date
*
MM
DD
YYYY
Parent or Legal Guardian (if applicant is under 18)
*
First Name
Last Name
Gender
*
Grade Completed
*
select one
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
College Age
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Contact Email
*
Date of Birth
*
MM
DD
YYYY
Contact Phone
*
(###)
###
####
Week Attending
*
Please check which dates you will be available. Check as many as possible. We may or may not need you to serve all weeks you have checked.
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone
*
Emergency Contact Relationship
*
What church do you attend?
*
Have you accepted Jesus as Lord and Savior of your life?
*
If yes, approximate date?
MM
DD
YYYY
Have you been baptized?
*
Have you ever worked with children?
*
If yes, please list what age group and in what setting below.
Have you ever been convicted of an offense involving a minor?
*
If yes, please describe the conviction(s) below.
Are there any facts or circumstances, including those that are physical or mental health related involving you or your background that would question your ability to be entrusted with the supervision, guidance and/or care of children?
*
If you prefer, you may discuss your answer in confidence with the children’s minister or you may explain below.
List any dietary requirements, health issues, medical conditions, allergies, etc.
Reference 1 Name (Do not list family members)
*
First Name
Last Name
Reference 1 Phone
*
(###)
###
####
Reference 2 Name (Do not list family members)
*
First Name
Last Name
Reference 2 Phone
*
(###)
###
####
T-Shirt Size
*
Adult S
Adult M
Adult L
Adult XL
Adult XXL
Adult XXXL
Applicant's Statement
*
The information I have given in this application is correct and complete to the best of my knowledge. I hereby grant Cornerstone Kids’ Ranch permission to do a background check on me. I hereby request any reporting agency Cornerstone Kids' Ranch should choose to release any information, which pertains to any record of convictions contained in its file maintained on me whether local, county, state, or national. I hereby release said departments from any and all liability resulting from such disclosure.
Social Security Number
*
Camp Assistant Basic Guidelines
*
1. Have a servant’s heart—like Christ.
2. Pick up after yourself. Our goal is to leave the site better than what we find it.
3. Leave shoes on the outside of the house along the wall not in the walkway.
4. Sheets must be placed on mattresses. We will provide the sheets.
5. No food/drink in the carpeted areas
6. If something breaks or an accident of any kind happens, let someone know so it can be taken care of.
7. You are not here to hunt for a boy/girl friend. No PDA will be tolerated-even if you are already considered an item!
8. Boys/girls stay out of each other’s area.
9. No weapons, including pocketknives
10. No drinking, drugs, or tobacco of any kind (this includes dip/chew)
11. All meetings are mandatory; morning meetings, chapel, daily wrap-up, nightly devotions, etc.
12. Everyone will have kitchen duty on a rotation basis.
13. Don't waste; this includes water bottles so please label them.
14. Turn lights out when leaving the room.
15. All scheduled times, including lights out, NO MORE TALKING, are to be followed.
16. CA’s will be allowed 1 snack and 1 soda per day from the Snack Shack. These will be available at only certain times determined by adult leaders.
17. Cell phones will not be allowed while children are present. There will be designated times in the evening when cell phones will be allowed.
18. Observe the dress code: Closed toe shoes, no midriff, no short shorts, no sagging pants or shorts, no low cut shirts, and no spaghetti straps.
19. Be an active participant throughout the day; while working with children, chapel, chores, etc.
20. Additional rules about appropriate ways to work with children will be discussed and followed.
21. Cornerstone Kids’ Ranch is not responsible for any lost or stolen items.
