Camp Staff Registration Form


Please type or print: 

Name: ___________________________________________________________________________

                                               Male – Female (circle one)

Home Address (Physical Location)_____________________________________________   City______________________________________  State____  Zip___________

Mailing Address if different______________________________________________________________________________________________________________________


Age _________                               Date of Birth _____________________________



Which Camp(s): Children’s____       Younger Youth____        Older Youth______   (Check One – Two – Or All)

Position Desired: _________________________________________________________


I give Fellowship Baptist Association permission to run a criminal record check on me for the purposes relating to camp. My social security number is: ________________________________________________________

_____________________________________________ Today’s date__________________________________

(Your signature)

Your signature is required for this check. If you do not sign this statement, we cannot use you in camp. This is for the protection of our children and is required of all camp staff.

PARENT/GUARDIAN (if under 18) ______________________________________________________________

I give permission to the camp nurse to provide the staff member first aid, provide minor health care as needed and furthermore to give permission to camp administration to secure professional medical aid as needed.


                                  (Parent or Guardian Signature)




Notary Public Date




HOME PHONE: ________________________ EMERGENCY PHONE NUMBER ________________________

CONTACT PERSON (relation to staff member) ____________________________________________________


PLEASE CHECK WHAT YOU HAVE HAD ____ ear infections, ____ heart trouble, ____ surgery, or serious health problems (please explain )_______________________________________________________________________________________________________________________________________________

_____ measles, ____ chicken pox, ____ dietary restrictions (explain) _________________________________ ______________________________________


PLEASE CHECK WHAT YOU ARE ALLERGIC TO: ___ bee sting, ___ penicillin, ___ poison ivy, ___ poison

oak, ___ sumac, ___dust and ____ other (explain) ____________________________________________________


Do you consider your health:  Fair ______ Good ______  Excellent______

Do you have any physical or mental defects which will impair your effectiveness as a staffer? If so, please explain:


Please read the following before signing your name.

I realize that if I am accepted to work at Fellowship Baptist Association Camp, I will be expected to comply with camp rules, attend all staff training sessions, study carefully the Handbook for Cabin Leaders before training sessions.

Signed: _________________________________________________________ Date ______________

School now attending Last grade completed

College Students, your major/minor ________________________________________________________________

Your College Address: _________________________________________ College Telephone: _______________



Are you a Christian: _____ Yes _____ No; if yes, how long: ______ T-Shirt Size_______________

Church Activities: (those you led or taught 1-12 grades: VBS, GA’s, RA’s, Day Camp, Backyard Bible Club, Sunday school, etc.)



Activities and organizations in school and community:



Briefly explain your encounter with Jesus Christ and how continuing encounter(s) have changed your life:




In your daily life, how do you share your faith with others?




What do you do on a regular basis to grow in your walk with the Lord?




Are you sensing a call to vocational/paid Christian service? ____ Yes ____ No If yes, in what area:


Active member of what church: ____________________________________________ Town/Community _______________________________


Pastor: I have reviewed this application and to the best of my knowledge, the facts listed are true and I am recommending this person for the position for which he/she is applying.

Pastor’s signature _____________________________________________________________________________________