2022 Staff

Staff Registration

Please complete the form below to register for your assigned week(s) of camp.

Please select which week(s) you are serving as a staff member:

Weeks of Camp *

Senior Week: July 3 - 8 Intermediate Week: July 10 - 15 Junior Week: July 17 - 22 All-Age Week: July 24 - 29 Singing Week: July 31 - August 5

* Indicates required field

Staff Name *

First

Last

Date of Birth *

Church Affiliation *

Mailing Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number #1 *

Phone Number #2 *

E-Mail Address *

Emergency Contact Name *

First

Last

Relationship *

Phone Number #1 *

Emergency Contact Name *

First

Last

Phone Number #1 *

Phone Number #2 *

Relationship *

Phone Number #2 *

Family Medical Insurance

Name of Insurance *

Policy Number *

Doctor's Name *

Phone Number *

Medical History

Please check all that apply. *

Heart Problems Stroke Seizures COPD Hypertension Asthma Diabetes Migraines N/A