"*" indicates required fields Step 1 of 7 14% General InformationFirst Name* Middle Name Last Name* Address* Street Address City – Select –AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email* Gender*– Select –MaleFemaleBirth Date* MM slash DD slash YYYY Age*Marital Status*– Select –MarriedNot MarriedSpouse's Full Name* T-Shirt Size*– Select –XXSExtra SmallSmallMediumLargeExtra LargeXXLAvailability* Camp 1 (Grades 5-8) Camp 2 (Grades 9-12) Desired Role* Mentor (Ages 21+) Guide (Ages 16+) Support Photographer Nurse Camp Director Program Director Activities Director Other Other Role* How did you hear about camp?* Website Social Media Word of Mouth Event Speaker Display Booth Other Other* Emergency/Medical InformationEmergency Medical Contact*Please provide two or more emergency medical contacts.Contact Full NameRelationshipEmailPhone Add RemoveAllergies/Dietary Restrictions Current Medications Medical Conditions Educational InformationHigh School Education Name* High School Location (City/Town, State)* High School Diploma*– Select –YesNoMost Recent Grade Completed* College Education Name College Location (City/Town, State) College Degree– Select –YesNoMajor Years Completed Employment/Volunteer InformationEmployment/Volunteer*Company/OrganizationTitleStart/End Date Add Remove ReferencesReference 1Name* Relationship* Years Known* Phone*Email* Reference 2Name* Relationship* Years Known* Phone*Email* Reference 3Name* Relationship* Years Known* Phone*Email* Faith BackgroundAttending Church Name* Pastor's Name* Affiliation/Denomination* Years of Attendance* Phone*If you have been attending this church for less than a year, please list your previous church as well.Previous Church Name Pastor's Name Affiliation/Denomination Years of Attendance PhoneAre you currently serving a ministry within your church?*– Select –YesNoWhat is your role?* In what ways are you actively engaged in a Christian community? (Bible study, Sunday school, etc)* In what ways are you independently engaged in your faith? (Prayer, Bible reading, Devotional, etc)* How have these experiences helped you to grow in your relationship with God?* Please provide a testimony of your salvation in Jesus or a way that God has been working in your life.*Hope’s Haven Statement of Faith We believe… In the Holy Scriptures as inspired by God, infallible in every respect, totally inerrant, and the only supreme authority in all matters of faith and conduct. In one God, eternally present in three persons, Father, Son, and Holy Spirit. The Lord Jesus Christ is God manifest in the flesh, His virgin birth, His sinless human life, His divine miracles, His resurrection, His ascension, and His personal return to this earth in power and glory. That salvation is received for lost and sinful man through the blood Jesus shed for our sins by faith, apart from works, and the regeneration by the Holy Spirit. In the Holy Spirit by whose indwelling the believer is enabled to live a holy life to witness and work for the Lord Jesus Christ. The unity in the Spirit of all true believers, the Church, the body of Christ Do you agree with the above statements?*– Select –YesNoPlease explain why* Acknowledgements/ExpectationsPlease thoroughly read through the following list. Arrive spiritually and physically prepared Fulfill assigned role and complete tasks as requested Read the handbook and complete training Respect the guidance and authority of those above you Work cooperatively with others Be willing and able to work with a diverse population Be sensitive and considerate of others differing opinions Help supervise all campers Make sure campers needs are taken care of Prioritize camper interaction over socializing with others Follow the schedule with punctuality Participate in all camp activities to the best of your ability Encourage campers to participate in all activities Help to keep the campsite area clean Encourage campers to clean up after themselves Have a willingness to share a testimony Keep a positive attitude, be enthusiastic, and have fun Expectations Agreement* I agree with the expectations that will be required of me and I will do my best to fulfill them. If an area is brought to my attention that I am falling short in, I will respect that correction and make an effort to change.*Camper Information Agreement* I agree to hold all information regarding campers (including names) confidential from anyone outside of Hope’s Haven. Breaching this agreement may result in my inability to serve with Hope’s Haven in the future.*Photography Consent I agree that any pictures taken of me at camp may be used promotionallyClearancesIn accordance with Pennsylvania Law, the following documents and signatures are required for those 18 and older. We require that all volunteers apply for Child Abuse Clearance and Criminal Record Check. You can find links to these clearances on our websites (under You Can Help -> Volunteer). If you need assistance obtaining these clearances, please contact us at info@hopeshavencamp.org. If you are not or have not been a resident of Pennsylvania continuously for the past 10 years, a Federal FBI fingerprinting is also required. In addition, we will need a Child Abuse Clearance and Criminal Record Check from your previous state of residence.Criminal Record Check* I understand and agree that Hope’s Haven may secure a Criminal Record Check on my behalf.*PA Resident Confirmation I certify that I have been a resident of Pennsylvania continously for at least 10 years.PA Child Protective Services Law* In accordance with Pennsylvania Child Protective Services Law, section 6344(c), I certify that I have not been convicted of any of the listed crimes or equivalent crimes in any other jurisdiction within the last five years.*Chapter 25 (relating to criminal homicide) Section 2702 (relating to aggravated assault) Section 2709 (relating to stalking) Section 2901 (relating to kidnapping) Section 2902 (relating to unlawful restraint) Section 3121 (relating to rape) Section 3122.1 (relating to statutory sexual assault) Section 3123 (relating to involuntary deviate sexual intercourse) Section 3124.1 (relating to sexual assault) Section 3125 (relating to aggravated indecent assault) Section 3126 (relating to indecent assault) Section 3127 (relating to indecent exposure) Section 4302 (relating to incest) Section 4303 (relating to concealing death of child) Section 4304 (relating to endangering welfare of children) Section 4305 (relating to dealing in infant children) Section 5902(b) (relating to prostitution and related offenses) Section 5903(c) (d) (relating to obscene and other sexual material and performances) Section 6301 (relating to corruption of minors) Section 6312 (relating to sexual abuse of children), or an equivalent crime under Federal law or the law of another state. The attempt, solicitations, or conspiracy to commit any of the offenses set forth in this paragraph. A felony offense under the act of April 14, 1972 (P.L233, No.64), known as The Controlled Substance, Drug, Device and Cosmetic Act InterviewsNew and returning volunteers: please provide three dates and times that you are available for an interview. These can occur via Zoom or in person.Interview Dates* Add RemoveSignaturesUnder 18 I am under 18 years of age. Parent/Guardian Signature* Parent/Guardian Email* Parent/Guardian Phone*Digital Signature* I understand that by submitting this form, I am signing this application electronically.* Δ