Counselor Application

General Information

Full Name

School Attending/or Graduating from

Age - How old will you be on June 1, 2024?

Date of Birth

T-Shirt Size

Phone Number

Street Address

City

State

Zipcode

Email (required)

Driver’s License Number

State Issued

Are you a US Citizen?
YesNo

If not, is it legal for you to work in the US?
YesNo

Social Media Accounts

Instagram Account Name

Twitter Account Name

Snapchat Account Name

Tik Tok Name

List any other social media accounts you use

Matters of Faith

What church do you attend & what is your present involvement?

Your Testimony: Briefly describe how and when you became a follower of Christ

Explain the plan of salvation as you would to a child:

Other than church, are you currently involved with a Christian organization/ministry? What is your role?

How would you describe your devotional life/time with God?

Have you ever led a small group or Bible study? If so, explain:

Counselor Details, Personal & Leadership Qualities

Camp Amplify requires all staff members to attend staff training, date & time TBA

Counselor in Training (CIT) does not need to pay Camp Amplify to be there

Payment for a week includes room and board

Counselor: $350 per week
Counselor in Training (CIT): $100 per week
Volunteer/Missionary: Not monetarily compensated.

Camp Amplify performs a background check on all Counselor, Counselor in Training, and Volunteer applicants to ensure the safety of our campers. Do you agree to allowing Camp Amplify to perform a background check?
YesNo

What summer staff position are you applying for? (Feel free to contact with questions
and full job descriptions.)
CounselorCounselor in TrainingVolunteer/Other Support

Do you have any previous camp experience? If so, list the name of the camp, your supervisor, and describe the position that your held:

Describe any experience you have in working with children

What have you learned from previous experiences that would help you serve and minister to campers?

Being a counselor can be a strenuous job that demands physical stamina with both emotional & mental stability. Counselors & CIT’s are on the job 24/7 with very little down time. Do you have any health conditions (physical, mental or emotional) or reservations that could potentially limit your ability to carry out this responsibility? If so, please explain below:

What skills or talents do you have that could be useful in a camp ministry that have not been mentioned?

Camp Amplify is non-denominational; therefore, serves kids from many different kinds of ministries. We focus on the basics of the Gospel message & leave issues such as Baptism, Healings, Speaking in Tongues, Prophecy, and Predestination to the local ministries. Are you able to respect this policy?

What is your strongest quality and why?

What is your weakest quality and why?

Miscellaneous

Please share how you live your life according to the below. (These issues are relevant to our summer youth).

Drinking: Do you drink? If yes, how often?

Smoking: Do you smoke? If yes, how often?

Vaping: Do you vape? If yes, how often & what substance?

Cannabis, THC, Marijuana: Do you smoke, ingest, vape, etc.? If so, in what manner & how often?

Drugs: Do you use illegal or non-prescribed drugs? If so, what & how often?

What are your views on?

Premarital Sex

Abortion

Homosexuality

Pornography

Have you ever been convicted of an offense involving a minor, or endangering the welfare of a child such as, child abuse, child neglect, etc., or any offense against a person, such as assault, etc.? If yes, explain

If you discovered that a fellow staff member was not obeying or reflecting the mission, vision, and policies of Camp Amplify, what would you do?

Do you acknowledge that you are applying for a position of ministry & that you will adhere to the policies set forth at Camp Amplify by actively supporting the mission and vision?
YesNo

I understand that electronic devices and cell phones are not allowed during camp. I also acknowledge that my cell phone will be collected by the administrative staff and returned to me at the conclusion of camp. Any violation of this policy could result in immediate dismissal from camp.
YesNo

Camp Amplify stresses the importance of being at camp 100% for the campers. Do you have this level of commitment?
YesNo

Camp Amplify asks that personal relationships be put on "Hold" during camp. There should be no romantic physical interaction with another person at camp, and no one at camp should be able to tell you are romantically involved with another person by your behavior. Can you abide by this policy?
YesNo

Personal References

Please give your Pastor (or Youth Pastor) and two other non-family references below. We will contact these references as part of your potential service.

Reference Name (1)

Reference Phone Number (1)

Reference Name (2)

Reference Phone Number (2)

Reference Name (3)

Reference Phone Number (3)

Medical Information

I am allergic to the following:

Medications:

Foods:

Other:

Do you have an EPI Pen?
YesNo

Please list any other medication conditions Camp Amplify should be aware of:

Any medication brought to camp must be turned in to the camp nurse and listed in the medications area of your application. If this is not followed, the camp nurse will add these medications to your application. Are you willing to abide by this policy?
YesNo

Name of Insurance Company:

Policy Number:

Insurance Company phone number:

Your doctor's name:

Your doctor's phone number:

Emergency Contact Name:

Emergency Contact Number:

Emergency Contact Relationship:

Please read the following medical, liability and image release. Below it, you can enter you name if you agree with the terms, and if you verify that all information given is true to the best of your knowledge

Medical and Liability and Image Release

The undersigned represents to Camp Amplify, a non-profit organization, that he/she is the legal guardian and natural parent or the legal guardian of the above named child; and the undersigned does hereby consent to such minor taking part in the Camp Amplify, with full understanding that insofar as such activity will involve but is not limited to traveling to and from camp in vans or busses, traveling to and from camp during staff breaks, eating food prepared by camp staff or local restaurants, swimming, horseback riding, camp sports, archery, that there is always the risk of injury, illness, loss, death, and possible consequent expenses for the medical, diagnostic, and curative treatments, and incidental loss and expense, and the undersigned does for him/herself and for and on behalf of such minor assume the risk of such expense and does hereby wholly release Camp Amplify and any representative from any responsibility or liability; and waives any claims or causes of action against it or its agents that might rise on account of loss, injury, death, or expense occasioned by any sort of accident or any other circumstances involving such child, and agrees to hold harmless in event any such claim should arise; and the undersigned agrees to abide by the rules and regulations, supervision and discipline set applied by Camp Amplify and its agents, and does hereby authorize Camp Amplify or its representatives or other agents arrange for any needed medical treatment or x-rays, and hold harmless Camp Amplify from any such expenses. The undersigned will reimburse Camp Amplify fully or furnish payment or insurance for any such payment, at his or her own expense. The undersigned also agrees to pay in full for any property damage caused by his/her own child. Permission is also given to the camp medical personnel to administer over the counter medication to the above-named child as needed. The undersigned also gives permission to Camp Amplify to use any image, video or written material that the above named child is in or wrote. Images and videos will be used for the sole purpose of promoting the camp and not for financial gain.

Applicant Signature of Release (type your full name):

Parental Signature (if under 18 years)

I acknowledge that I will receive a 1099 form from Camp Amplify for income earned. This form will also be reported to the IRS as income.

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