Circle Y Ranch Camp
Volunteer Application
Contact Information (Please Print Only)
Name
Birth Date
Street Address
City ST ZIP Code
Home Phone
Work Phone
Driver’s License Number
Expiration Date
State
E-Mail Address
Availability
What times are you available for volunteer assignments? (check all that apply)
___ Weekday Mornings ___Weekday Afternoons ___ Weekend Mornings ___ Weekend Afternoons
Are you available for Camp Cleanup Week? (Please check below)
___ 4/27/2014 – 5/3/2014
___ 5/4/2014 – 5/10/2014
___ 5/11/2014 – 5/17/2014
What is your availability for Overnight Camp Volunteer Assistance June 16 – August 9, 2014?
(record below)
____________________________________________________________
____________________________________________________________
____________________________________________________________
Interests
Tell us in which areas you are interested in volunteering.
___ Camp Clerk
___ Camp Counselor
___ Camp Kitchen Staff
___ Camp Gardner
___ Fundraising Committee
___ Camp Building & Grounds Maintenance
___ Camp Ministry or Evangelical Team
___ Camp Life Guard
___ Camp Nurse (You must be licensed as an LPN or RN)
___ Camp Golf Outing Fundraiser – Chicago, IL
___ Camp Golf Outing Fundraiser – Detroit, MI
Have you ever been convicted of or pleaded guilty or no contest to any criminal offense of any kind? If so
please explain: ______________________________________________________________________________
__________________________________________________________________________________
What Church are you a member? ________________________________________________________
Address _______________________________City__________________State____Zip Code________
Pastor’s Name _____________________________________Church Telephone No.________________
Why would you like to serve at Circle Y Ranch? _______________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
What do you use for personal devotional time? _______________________________________________
Please briefly state your relationship to Christ? (You may attach an additional sheet, if desired.)___________________
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____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Please record the names of three references. Do not list family members or relatives.
Contact with references is required and is a condition of approval. The references must be over 18 years of age.
Please alert your references that someone from Circle Y Ranch will be contacting them regarding your application.
Previous Volunteer Experience or Training (Summarize your volunteer experience below.)
Agreement and Signature
I affirm that the facts set forth are true and complete. I authorize any references or churches listed in this application to give you any
information that they may have regarding my character and fitness for children or youth work. . I authorize that a criminal records
check be conducted on me and that any information which pertains to any record of convictions contained in police files or any
criminal file maintained on me whether state or local be released to Circle Y Ranch. I release any individual, church, youth
organization, charity, employer, reference, Police Departments, Circle Y Ranch or any other person or organization including record
custodians, both collectively and individually and those individuals receiving the results of the check from any and all liability for
damages of whatever kind or nature in regard to their release of information or such disclosure. I also waive any right I may have to
inspect any information provided about me by those identified on this application. I understand that if I am accepted as a volunteer,
any false statements, omissions, or other misrepresentations made by me on this application may result in my immediate dismissal.
Name (printed)
Signature
Date
Our Policy
It is the policy of this organization to provide equal opportunities without regard to race, color, religion, national origin, gender, age,
or disability. We are committed to placing individuals who have no record of previous conviction for child sexual or physical abuse;
for whom we receive positive responses from their personal and professional references, in addition to the Circle Y Ranch official
background check; and who meet the qualifications of the position for which they are applying. Should information be received that
is questionable, the individual will be asked to meet with the Camp Director and/or Camp CEO to clarify the questionable issues
prior to being placed in a position that relates to working with campers.
Thank you for completing this application form and for your interest in volunteering with us.
EMAIL YOUR COMPLETED APPLICATION TO: SARRINGTON@CIRCLEYRANCH.ORG
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