Name

Please include maiden name and any alias names you may go by.

First Name

Last Name

Date of Birth

YYYY

Gender

Junior Staff - Grade

If Junior Staff

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Best Phone number to contact you

Phone

(###)

###

####

Church Affiliation

T-Shirt Size

For Staff Shirts

Children Eligible for Daycare

Please list the name and age of each child eligible for Daycare Program. Camp Ao-Wa-Kiya’s Daycare Program is limited to children who are 4-10 years of age. We ask that you make other arrangements for children who will not be campers or be eligible to serve as Junior Staff.

Weeks you plan to volunteer:

Volunteer Positions you are interested in:

Staff Positions

Please check the position(s) in which you would be willing to serve

Senior Counselor

Junior Counselor

Daycare

Health Officer (Nurse)

Life Guard

Assistant Program Director

Maintenance

Groundskeeping

Housekeeping

Please tell us of Experience you may have had in any of the above areas

Food Service Positions

Please check the position(s) in which you would be willing to serve.

Food Prep

Dining Room

Dish Room

Please tell us of Experience you may have had in any of the above areas

Certifications you hold:

Skills/Certifications

Please mark the following that you have current certifications in:

Lifeguard

Lifeguard Trainer

CPR/AED

First Aid

CDL

Nurse License

Please mark your ability level on each of the following areas

1=Very Experienced/Could Teach; 2=Some Experience; 3=No Experience

Challenge Course Ability

Rock Climbing Ability

Paintball Ability

Outdoor Life Ability

Horsemanship Ability

Worship Ability

.22 Riflery Ability

Air Riflery Ability

Archery Ability

Woodcraft Ability

Handcrafts Ability

Photography/Video Ability

Sailing Ability

Canoeing Ability

Fishing Ability

Swimming Ability

Wake Boarding Ability

Kayaking Ability

Musical Instrument(s) You Play

Please tell us of Experience you may have had in any of the above areas

Reference 1 - SPIRITUAL MENTOR (Pastor or Small Group Leader)

Reference 1 Name

First Name

Last Name

Reference 1 Relationship (Non-Relative)

Reference 1 Email

Reference 1 phone

Reference 1 Phone

(###)

###

####

Years Known Reference 1

Reference 2

Reference 2 Name

First Name

Last Name

Reference 2 Relationship (Non-Relative)

Reference 2 Email

Reference 2 Phone

(###)

###

####

Years Known Reference 2

Reference 3

Reference 3 Name

First Name

Last Name

Reference 3 Relationship (Non-Relative)

Reference 3 Email

Reference 3 Phone

(###)

###

####

Years Known Reference 3

Your Salvation Experience

Your Relationship to God

Your Church Attendance

Been Convicted of a Crime (Other than Minor Traffic Violations)?

If Yes, Explain:

Do You Have Any Physical Limitations (if Yes please explain)

Do You Have Any Communicable Diseases?

If Yes, Please Explain:

Staff Agreement

Realizing the great responsibility and opportunity of working with children at Camp Ao-Wa-Kiya, I agree to: Sacrifice personal desires in the interest of the campers; Cooperate with the directory and other leaders under whom I serve; Obey camp and staff regulations printed in the staff manual; Endeavor to be a blessing to the campers with whom I work by helping to enrich their lives spiritually, physically, and mentally; and Uphold the standards and doctrinal position of Camp Ao-Wa-kiya (a copy of the doctrinal statement may be obtained at ao-wa-kiya.org). I hereby release and agree to hold harmless from liability any person or organization, whether listed or not, who provides information or references about me to Camp Ao-Wa-Kiya. I waive any right I might have to inspect references provided on my behalf. I certify that I have neither been convicted of, nor am I the subject of pending charges, for any offence involving actual or attempted child abuse or sexual molestation in any jurisdiction. If you agree, write your full name below.

Thank You for Volunteering!

You can also Print an application by right clicking, select print, complete and then mail it to the 8401 W THOMAS PIKE SHELBY MI 49455