Volunteer and Have Fun at Interfaith Peace Camp!
Consider becoming a Junior Counselor for the 2015 Interfaith Peace Camp
This is a fun and unique volunteering opportunity that you will never forget!
Who
Teens, age 14 or older, interested in helping with the 2015 Interfaith Peace Camp
When
Junior Counselor Orientation: May 30 9:00 a.m. - 1:00 p.m. & June 7 2:00 p.m. - 6:00 p.m.
Interfaith Peace Camp: June 8-12 8:30 a.m. - 2:30 p.m.
Where
Eastern Mennonite University
FREE Admission and Lunch!
Registration Please complete the attached registration form and return it to the Center for Interfaith
Engagement at EMU by May 8, 2015.
About Interfaith Peace Camp
Interfaith Peace Camp, rooted in Abrahamic faith traditions, is a weeklong day camp offered for children ages
8-12 who are interested in building friendships with and understanding among their peers from other
Abrahamic faith traditions in the Harrisonburg/Rockingham community. Our theme for 2015 is, ‘Earth Care –
People Care.’
Role of Junior Counselors
Junior Counselors are an important part of the camp. You will be essential to helping our 30+
campers, ages 8-12, have a fun and enriching experience at Interfaith Peace Camp (IPC). This year we'll think
about the ways to build relationships among people of Abrahamic faith traditions. As we have done in the past,
we will visit the Jewish temple, the Islamic mosque and a Christian church to explore three different Abrahamic
faith traditions. Of course, we'll have lots of good food, fun arts and crafts, and time to play outside with
friends, old and new.
As a Junior Counselor, your main responsibility is to help the lead counselors ensure that every camper has a
positive experience. Some of the Junior Counselor jobs include:
 leading small groups of campers
 helping to prepare, set-up and clean-up snacks and meals
 preparing art materials
 assisting the art, PE and music teachers
 acting as a positive role model for all campers
Junior Counselor Orientation, May 30 & June 7, will include fun activities for all junior counselors to get
to know each other, prepare some of the materials for the camp, and to learn and practice skills that will lead
to an effective and positive camp experience.
To sign up, complete the attached registration form. You must attend orientation to be considered as a junior
counselor for the 2015 Interfaith Peace Camp.
For more information please email questions to
Thank you!
peacecamp@emu.edu.
Interfaith Peace Camp
Junior Counselor Application
*You may apply to be a junior counselor if you are 14 years old or older.
Name: ____________________________________________________________________
Last (Family Name)
First (Given) Middle
Current Address: _____________________________________________________________
Street Address
City
Email Address: ____________________________
Gender: ___Male ___Female
State
Zip code
Phone(s): _________________________
Date of Birth: ______________________________________
Parent(s) or Guardian(s)
Mr./Mrs./Ms. ________________________________________________________________
(circle one)
Name
Daytime Phone
E-mail
Mr./Mrs./Ms. ________________________________________________________________
(circle one)
Name
Daytime Phone
E-mail
Emergency Contact: __________________________________________________________
Name
Relation to Junior Counselor
Phone Number
Special dietary or other needs _________________________________________________________
Why do you want to be a Junior Counselor? _____________________________________________
_________________________________________________________________________
________________________________________________________________________
_________________________________________________________________________
Check all activities you consider yourself to be good at:
__ art activities
__ singing
__ playing an instrument
__ acting
__ leading discussions __ preparing art materials
__ preparing for meals
__ setting-up and cleaning-up for the meals
Please check the statements that reflect that you understand and commit yourself to the following:
______ I will be able to attend Interfaith Peace Camp at EMU EVERY DAY, ON TIME on June 8th-12th from
8:30 a.m. -2:30 p.m.
______ I will be able to attend Interfaith Peace Camp Orientation on May 30th 9:00 a.m. - 1:00 p.m. and June 7th
2:00 p.m. - 6:00 p.m.
______ I will contribute to the Interfaith Camp experience by sharing my skills and talents.
______ I understand that my primary responsibility is to help ensure the safety and well-being of the campers and
to help the lead counselors.
Please list any questions and concerns you may have.
_________________________________________________________________________
__________________________________________________________________________
_________________________________________________________________________
Reference: ________________________________________________________________
Name
Phone
Email
_________________________________________________________________________
Applicant’s Signature
Date
_________________________________________________________________________
Parent’s Signature
Send your application by May 8, 2015 to:
Center for Interfaith Engagement
Eastern Mennonite University
1200 Park Road
Harrisonburg, VA 22802
Date
OR
Scan and email to: peacecamp@emu.edu
Interfaith Peace Camp
Medical Waiver Form
Allergies or medications ________________________________________________________________
Family Doctor ______________________________ Phone # __________________________________
Medical Insurance Co. _________________________________________________________________
Plan/Policy # _____________________________ In whose name? _____________________________
I give permission for my child, ______________________________ , to participate in the Interfaith Peace Camp
Orientation on May 30 & June 7 and as a Junior Counselor in the Interfaith Peace Camp 2015 from June 8th-June12th
2015. I understand that my child will be transported to and from different places of worship during the Camp. I release
Eastern Mennonite University (EMU) and other faith communities sponsoring the Interfaith Peace Camp 2015, as well as
staff and volunteers, from liability for any injury or illness that my child may sustain during this summer day camp. In the
event of an emergency, if none of the persons named on this Medical Waiver Form can be reached quickly, I grant each
adult leader in the Camp the right to authorize any examination, diagnosis, treatment or hospital care advised and
supervised by a licensed physician, surgeon, or dentist. I expect to be contacted as soon as possible. I agree to indemnify
and hold harmless EMU and other faith communities , staff and volunteers (i) from any and all claims or losses at any time
arising, (other than those resulting from the gross negligent or willful misconduct of EMU, faith communities, staff and
volunteers) related to the Camper’s bodily injury, property damage or wrongful death arising out of Camper’s participation
in the Camp, and (ii) from any claims, actions or losses, at any time arising, related to Camper’s negligence or misconduct
during the Camp.
Emergency Contact _____________________________________ Phone # ______________________
Emergency Contact _____________________________________ Phone # ______________________
Signature of Parent/Guardian ________________________________ Date ______________________