Counselor In Training Application Form | Northwest Regional Christian Church (Disciples of Christ)

Personal Identifying Information

First Name *

Middle Initial *

Last Name *

Maiden Name or Alias *

Address *

City *

State *

Zip Code *

Primary Phone Number *

Include Area Code

Alternate Phone Number

Include Area Code

Primary Email Address *

Birth Date *

Month

Day

Year

Gender *

Your Church *

What church are you a member of or do you attend at regularly?

Volunteer Information

Age Group(s) *

What youth age groups or programs are you interested in volunteering with?

Kids (Grades 2-3)

Junior (Grades 4-6)

Skills and Interests

What special skills/interests do you have that might be relevant to the NWRCC Summer Camp/Winter Retreat programs (i.e. bible study, music, sports, crafts, hiking, etc.)?

Background Check Information

Have you ever been disciplined for, charged with, or convicted of an act of sexual misconduct or child sexual abuse? *

Yes

No

If yes, please explain:

Have you ever been convicted of a felony? *

Yes

No

If yes, please explain:

Attenion

The NWRCC is authorized to conduct criminal background checks on volunteers working with minors. All persons participating in NWRCC events for youth must agree to the request for Criminal History Information as per the Child/Adult Abuse Information Act, RCW 43.43.830 through 43.43.845.

With your digital signature below you are acknowledging you understand this background check will be done. A copy of the report will be provided to you at the email address given above.

Covenant

I desire to serve as a volunteer working with youth for the NWRCC. I understand that the references I indicate may be contacted to confirm my character and abilities as appropriate for leadership at the events I participate in. I promise to cooperate with other counselors, directors and staff and to uphold all standards set forth by the Region and the event leadership. With God’s help, I will seek in every way to provide an experience on the highest Christian level for all who attend the event which I serve. I will participate in all training opportunities planned for the event and at all times will conduct myself as the Christian example I am called to be.

I understand this application is good for three years from the date this form is submitted and will need to be completed again at its expiration.

Sign to Authorize
Background Check

Parent or Guardian

I understand that my minor child is applying to participate in NWRCC events as a Counselor-In-Training and I give my consent for their participation in that leadership position. I also give my consent for the background check described above to be completed in my child’s name. *Checking this box represents your digital signature for permission and authorization. Your youth cannot receive approval to participate as a Counselor In Training in the Northwest Regional Christian Church (Disciples of Christ) summer camp programs without this consent and background check.

Permission and Background Check Authorization- Parent or Guardian *

Yes

No

Name of Parent or Guardian: *

Parent or Guardian: Please type your name here.

Youth Applicant

By checking this box I state that I have read and agree to the authorization information above. *Checking this box represents your digital signature and authorization. You cannot receive approval to participate as a Counselor In Training in the Northwest Regional Christian Church (Disciples of Christ) summer camp programs without this consent and background check.

Background Check Authorization- Youth *

Yes

No

Essay

Essay *

Explain why you would like to participate as a Counselor In Training and (2) speak about the ways in which your experience, gifts, skills, training, and interests will lend to the overall camping experience (staff and campers) of those with whom you will work as a Counselor In Training.

References

Two References are necessary for a complete application.

One reference must be your pastor. In the case of clergy applying the Regional Minister or a clergy colleague may be substituted. For those congregations without a called pastor the Moderator/Chairperson of the church board or Youth Group Leader may be substitutd.
In addition to one reference from a minister select one person familiar with your character as it relates to working with children or youth.
Do not include a relative or significant other; the two references should not be related to one another.
YOU ARE RESPONSIBLE FOR YOUR REFERENCES RETURNING THEIR FORMS TO THE REGIONAL OFFICE.

Reference Forms

You can download a paper copy of the Reference Form at: https://disciplesnw.org/sites/default/files/doc/AdultVolunteerApplicationReferenceForms.pdf

Your Reference may fill out a form online with a digital signature at: https://disciplesnw.org/article/adultvolunteercitreferenceform

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