Applicant Information

Deadline to submit Paid Staff Application for ALL camps is February 28, 2025.

NOTE: NO Paid Staff application will be accepted onsite the first day of camp. This is strictly a pre-approval application process.

Complete and sign all parts of the application. Those who can work multiple camps will be considered first. If you are approved, you will be notified, and additional paperwork must be completed before you begin your position at youth camp.

Minimum age requirements for Paid Staff: Nurse- 20 yrs (LPN or RN certification), Cook- 18 yrs, Dishwasher- 15 yrs, Lifeguard- 18 yrs (Youth Camp) 16 yrs (Kids Camp) and must be Red Cross Certified.

Type Name to agree to the above statement

Select Position(s) For Which You Are Applying

Select Camp(s) For Which You Are Applying

Personal Info

Name

If Female, List Maiden Name

Mailing Address

Home Phone Number

Cell Phone Number

Date of Birth

Age

Biological Gender

Male
Female

Emergency Contact

Emergency Contact Phone

More Information

Name of Church & City

How long have you attended your church?

Checkbox

Check here if less than 10 years

List name and location of other churches in which you were a member, or regularly attended during the past ten years.

Conversion Date

Date Received Holy Spirit

I have worked Arkansas District Camp(s) in the past?

List positions you have worked

Check here if you have medical training (i.e. RN, LPN, EMT, First Aid Certification)?

Please explain your medical training

Personal Information

Do you currently use tobacco, alcohol, or any illegal drugs

Have you ever been accused , charged, or convicted of a criminal offense, excluding traffic violations

If yes, you must explain:

Have you ever been accused, charged, or convicted of child abuse or a crime involving any sexual misconduct of/with a minor or any other person?

If yes, please explain

Medical Information

Do you have any physical handicaps or conditions which limit your performance?

If yes, please explain

List any medications to which you are allergic. If none, indicate "none" or "n/a"

Name of Insurance Carrier (if none, please indicate here and in all the following boxes)

Insurance Co. Phone Number

Policy Number

Group Number

Subscriber's Name

Subscriber's Date of Birth

Name of Family Physician

Physician's Phone

Employer's Name/Address/Phone # (N/A if not applicable)

Upload a copy of your insurance card - front and back

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Certification

I hereby certify that all above information is true and accurate to the best of my knowledge

I, the undersigned, agree to the terms above.

Date Field

Applicant's Statement:

+The information contained in this application is correct to the best of my knowledge, information, and belief.

+I, the undersigned, hereby authorize the director or other responsible staff acting on behalf of the Arkansas District Council, to act as my Agent, to consent to medical, surgical or dental examination and/or treatment. In case of emergency, I hereby authorize treatment, and/or care at any hospital. If there is an emergency, please contact the above emergency contact.
+I acknowledge that participation in all camp-related activities necessarily involves risk of physical injury. I attest that I am physically capable to participate in this event. however, should directors, representatives or volunteers determine in their sole discretion that completion or participation in any games or events would be injurious to my health, or should I become ill or injured, I consent to my removal and treatment by any physician or medical care provider at the direction of the event director and/or assistant.

+I give my permission for free use of any videotape, photographs, audiotapes, or any other visual or audio reproduction in which I may appear by the Arkansas Assemblies of God. I release the Arkansas Assemblies of God from any liability connected with the use of picture or voice recording as part of any promotion.

+I understand that the Arkansas District Camps and the rented facility make rules and guidelines that I will abide by while attending camp. I agree to be given any position or assignment, be placed in any room, and if need be, go beyond the duties of the assigned position.

+In addition, I will pay for any damage I have done to the camp or to personal property belonging to another individual. I give permission to the camp director and/or assistant camp director to inspect the contents of any/all of my personal belongings, and to withhold and/or dispose of any improper or illegal contents.

+Should my application be accepted, I agree to be bound by the policies of the Arkansas Assemblies of God, including all camp rules, and to refrain from unscriptural conduct in the performance of my services on behalf of the camp.

I, the undersigned, agree to the terms above.

Date Field

Ministry Covenant and Agreement

Click HERE to watch the Camp Training Video, review, and sign the Covenant Agreement on our website.

*This can be completed after the submission of this application.

National Background Check and CMCR Form

***This section CAN be completed upon being hired.***

Download and complete the two forms below. Submit completed forms online at:

Summer Camps — Arkansas District

NOTE: Both forms must be Notarized.

FORM 1: Disclosure Regarding Background Check Investigation --> Authorization and Release 2025.pdf

Form 2: Child Maltreatment Central Registry--> CMCR 2025.pdf

Do you need the District Office to run your background check? (A $25 fee will incur.) ($25.00)

Pastoral Recommendation

***This section is required as a part of the application process.***

Forward the link below to your Senior Pastor to be completed online.

https://www.araog.org/asmform

2025 Camp Paid Staff Application