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 waiver and 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

Waiver and Release.  Counselor covenants not to sue and does hereby release, forever discharge, and agree to hold harmless and fully indemnify Camp Amplify Inc. and its affiliates, officers, directors, staff, employees, agents, volunteers, counselors, sponsors, heirs, administrators, successors and assigns (the “Released Parties”), from any and all liability, claims, demands, damages, expenses, and causes of action of whatever kind or nature, either in law or in equity arising out of or relating to (i) Counselor’s participation in Camp Amplify Inc. events (ii) Counselor’s performance or non-performance of counselor work and (iii) first aid or medical treatment provided to Counselor in connection with his or her participation in events and counselor work with Camp Amplify Inc. Without limiting the generality of the foregoing, Counselor understands and acknowledges that the foregoing covenant not to sue, release, discharge, and agreement to hold harmless and fully indemnify discharges the Released Parties from any liability or claim that Counselor may have against a Released Party for bodily injury or property damage, regardless of whether such injury or damage is caused in part by the act or omission of a Released Party. Notwithstanding the foregoing, nothing in this release shall be interpreted as requiring Counselor to indemnify, defend, or hold harmless a Released Party from any liability, claims, demands, or causes of action caused solely by that Released Party’s gross negligence or willful misconduct. Counselor agrees that the release, discharge, and agreement to hold harmless and fully indemnify set forth in this release are intended to be as broad and inclusive as permitted by law.

Assumption of the Risk. Counselor understands that participating in Camp Amplify Inc. events and his or her counselor work may involve activities that may be hazardous to the Counselor and inherently dangerous risks, including but not limited to horseback riding, camp sports or amusement rides, swimming and traveling to and from camp or parks in vans or busses and Counselor understands that there is a possibility of accidental or other physical injury or death to Counselor or of loss or damage to Counselor s property. Counselor hereby expressly and specifically assumes the risk of damage, injury, harm, or death in connection with such participation and counselor work. In addition to any other risks posed by participating in events of Camp Amplify Inc. and his or her counselor work, Counselor understands that, despite any safety precautions being taken by Camp Amplify Inc., by participating in events and being a counselor with Camp Amplify Inc., there is a risk of potential exposure to COVID-19 or any other harmful virus or bacteria, which may result in illness or death.

Medical Treatment. Counselor hereby grants permission for first aid and/or C.P.R. to be given to Counselor in an emergency, as determined in the sole discretion of any employee, staff member, or agent of Camp Amplify Inc.  Counselor further agrees that (a) Counselor will be solely responsible for any medical costs or expenses or any loss, liability, or damage which may arise as a result thereof, (b) Camp Amplify Inc. (including its employees, staff members, and agents) may act on Counselor’s behalf in securing medical treatment for Counselor in the event of injury or illness to Counselor, and (c) Camp Amplify Inc. may act on Counselor’s behalf in accepting financial responsibility for any such first aid and/or other medical treatment secured for Counselor (which responsibility shall be borne solely by Counselor).

Photographs and other Media Release. Counselor agrees to allow Counselor to be photographed or recorded in other media, such as video or audio recordings, in connection with activities or events of Camp Amplify Inc. Counselor understands and agrees that the photographs and/or other media recordings may be used to promote Camp Amplify Inc. and/or its services and events. Counselor hereby irrevocably grants and conveys unto Camp Amplify Inc. all right, title, and interest in any and all photographic images and other media recordings taken of Counselor during activities and events of Camp Amplify Inc., including, but not limited to, any royalties, proceeds, or other benefits derived from such photographs or other media recordings. Counselor understands and agrees that Counselor is waiving all rights to privacy and ownership regarding the use of such photographs and other media recordings.

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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