Staff Application

STAFF MEMBER INFORMATION (* indicates required info)

Interested in working at Ne-O-Tez this summer? Here's what you need to do:
First: fill out this form. Staffers under 18 must have a parent sign their application.
Second: Wait for a director to contact you. Please note: completing a staff application form does not guarantee a position as a counselor or staff member. You will be notified if your service is needed.
Third: After you are notified that you will be a staff member, please watch the safety presentation and take the 10-question quiz. Your director will send you appropriate links.

Staffer's First Name *

Last Name *

Nickname

Gender at birth *

Identifying gender

Current grade (if applicable) in 2022-2023 school year *

Type a number. Put 99 if not in school.

Address *

City *

State *

ZIP Code *

Birth Date *

Marital status

Name of others living with you and relationship to each

Email *

This is the main address where we will contact you. Please be sure it is spelled correctly.

Phone Number *

This is the main phone number we'll use to contact you. Cell phone is best, but home phone is good too.

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Yes, please send the quarterly email newsletter to the above email address.

No, I already have subscribed.

No, thanks.

Camp does not share or sell email addresses. You may unsubscribe at any time.

Tell us about your past service.

Home Church *

We are looking for the church you serve with the most.

Do you hold any leadership position at your church? (if so, describe.)

Are you a baptized believer? *

Yes

No

When were you baptized?

If you know the specific day, great! Otherwise, a month and a year will do.

Have you ever been a camper at Camp Ne-O-Tez? *

Yes

No

What weeks have you been a camper?

List the year and week (e.g. 2018-All Ages, 2019-3rd-5th Grade Boys, etc.)

Have you ever been on staff at Ne-O-Tez? *

Yes

No

If you've been staff, tell us how you've served in the past.

Include the year, week, director you served, and a description of the service (e.g. In 2018, I was dishwasher for 3rd-5th grade boys. In 2018 and 2019, I worked as a craft helper at PreCamp, etc.)

What other experiences have you had in servant leadership roles with younger kids?

Tell us about any other experiences in or out of church activities where you served.

Tell us about your desire to serve

God can use you to train youth to walk with Christ. How can we help you to join with us and serve this summer?
Please note that sharing your interest in working a week does not guarantee that you have been accepted to work that week. Staff for each week will be determined by each week's individual director.

Please check the first session you wish to staff or counsel. Your application will be sent to the director of that week. *

High School (9th-12th grade co-ed)

Pre-Camp (K-2nd grade)

Middle School (6th-8th grade co-ed)

Girls' Session (3rd-5th grade girls)

Boys' Session (3rd-5th grade boys)

All Teen (6th-12th grade co-ed)

Staff role that interests you (first session) *

Counselor

Dishwasher

OtherOther

Please explain what "other" role you have in mind.

Want to serve a second week? Please check the second session you would like to work. Application will be sent to the director of that week.

High School (9th-12th grade co-ed)

Middle School (6th-8th grade co-ed)

Girls' Session (3rd-5th grade girls)

Boys' Session (3rd-5th grade boys)

All Teen (6th-12th grade co-ed)

Staff role that interests you (second session)

Counselor

Dishwasher

Please explain what "other" role you have in mind.

Please tell us about your lifestyle choices

It is our responsibility to seek a staff that is able to provide healthy, safe, and nurturing relationships for everyone involved with Camp. Please answer the following questions with that in mind. Any special concerns can be discussed directly with a Camp Director or Ne-O-Tez board member personally.

Are you struggling with using any kind of drugs? *

Yes

No

Have you ever been arrested for/convicted of a crime? *

Yes

No

Are there special issues or concerns in your past or in your life right now that, if discovered, would have an impact on your commitment and involvement with Camp or on the relationships with staff and campers in the role you are seeking? *

Yes

No

Do you have posts on social media (Instagram, Twitter, Facebook, etc.) that would cause concern for a director or parent of a child that you might be counseling? (Your director may want to follow you on social media.) *

Yes

No

REFERENCES

Please list three references that we may contact to determine whether or not you would be a good fit for our weeks of Camp. By listing them below, you are giving us permission to contact them on your behalf.

First Reference - Name *

First and Last Name

First Reference - Relationship to Staff Applicant

How do they know you?

First Reference - Phone *

First Reference - Email *

Second Reference - Name *

First and Last Name

Second Reference - Relationship to Staff Applicant

How do they know you?

Second Reference - Phone *

Second Reference - Email *

Third Reference - Name *

First and Last Name

Third Reference - Relationship to Staff Applicant

How do they know you?

Third Reference - Phone *

Third Reference - Email *

In case of emergency:

Please provide the name of a person who could contact you in case of emergency. *

Emergency contact phone number *

MEDICAL AUTHORIZATION AND RELEASE FORM

This section must be completed to attend Camp.

Camper's Name *

Insurance Company *

Insurance Phone Number *

Policy Number *

Group Number *

Allergies *

None

Allergic to:Allergic to:

Please check and describe in pop-up box below.

Please describe the allergen(s), allergic reaction, severity, frequency and last episode.

Doctor *

Office Number *

Exchange Number

Please provide month and year of last tetanus vaccination. *

This staffer has NO chronic health concerns, except as checked below (select all that apply):

Please provide information for each checked item. Bring any medication in the original container with the amount needed for the duration of the camp session.

MEDICATIONS Medications below are used to manage illness or injury and will be dispensed by our First Aid worker, as needed. Check all those that you should NOT be given.

Emergency Authorization and Release: By signing below, I the staff member and/or, the parent or legal guardian of the staffer (hereby referred to as “my staffer”), certify that he/she has my approval to participate in all activities during a camp session. I also certify that the above information is accurate. By signing below I give my permission to camp personnel to administer medications listed above, unless checked, and medications that are supplied by me for my staffer. In the event I cannot be reached in an emergency, I hereby give permission for my staffer to be transported to and receive medical treatment. I understand I assume financial responsibility for expenses incurred for said treatment. I release and hereby agree to hold harmless the camp, director and staff and any other agents from any and every claim arising, which may be asserted by me or any member of my family, by reason of participating in any activities associated with Camp Ne-O-Tez. Further, I release the owner of properties on which the camp is located. This form may be copied for use outside of Camp Ne-O-Tez. I agree that matters of public health and safety will be directed by Ne-O-Tez policy and the judgment of the Director of the week and/or the Camp Ne-O-Tez Board of Directors. Media Release: Further, for valuable consideration received, by signing below I hereby irrevocably grant to Camp Ne-O-Tez, Inc. the worldwide, royalty-free, right to use my (or my staffer's) voice, likeness and image in any forms and media, in all manners for any lawful purposes, commercial or noncommercial.

Staff Member's Signature *

Clear

Use your trackpad to draw your signature or to type your name as a signature, choose the Type It tab and click in the upper left corner of the box to type your signature. Your electronic signature is legally binding in Missouri.

Date *

Parent/Legal Guardian's Signature (required for staffers under 18.)

Clear

Use your trackpad to draw your signature or to type your name as a signature, choose the Type It tab and click in the upper left corner of the box to type your signature. Your electronic signature is legally binding in Missouri.

Date

Commitment and Integrity Statements

Staff Training - Each director will decide when to train his own staff. Please check all that apply. Your director will contact you for final details.

I would be available for group staff training on March 3-4.

I would be available to arrive early on Sunday before camp.

I would be available to arrive by early afternoon (after lunch) on Sunday before camp.

I cannot arrive until Sunday late afternoon.

Integrity Statement - By checking "I Commit" below, I commit to attending or being available for the events I have registered for on this form with the exception of emergencies. I also understand my ability to follow through on my commitments can positively or negatively influence my potential Director's decisions about including me in their summer staff.

I Commit

Safety Training - Each staff personnel will be required to watch a health and safety video and will be given a quiz to make sure the material has been reviewed.

I agree that I will take the online safety training.

I will NOT be able to take the online safety training.

Robots cannot apply.

Please check the box. Thanks.

STAFF MEMBER INFORMATION (* indicates required info)

Tell us about your past service.

Tell us about your desire to serve

Please tell us about your lifestyle choices

REFERENCES

In case of emergency:

MEDICAL AUTHORIZATION AND RELEASE FORM

Commitment and Integrity Statements

Robots cannot apply.

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