Camp Blue Haven

Returning Counselor Application
Please print or type and include a current photo

Name __________________________________________________ Cell  Phone ______________
		Last			First			Middle
Present Address (College if applicable)
________________________________________________________________________________
			Street or Box			City		State	Zip		Phone
Parents’ Name _______________________________/ __________________________________
				Father						Mother
Permanent Address__________________________________________________________________________
			Street or Box			City		State	Zip		Phone
E-mail address ____________________________________________________________________
 
Date of Birth __________ Age _______ Sex ______Social Security Number ____________________

Have you been baptized into Christ?_______________ 
How many years have you been a Christian?  __________
Are you faithfully attending a church of Christ? __________

@ HOME:
Place of home membership/Town _____________________________________________________
Preacher's Name __________________________________Phone____________________________
Elder’s Name ____________________________________ Phone ___________________________
Elder’s Name ____________________________________ Phone ___________________________

@ COLLEGE if applicable:
Place of college membership/Town ____________________________________________________
Minister who knows you there_______________________________ Phone ___________________
Elder’s Name ____________________________________ Phone ___________________________

This position requires that you are available to work 10 weeks in the summer from May 26 - Aug 6th.
If you have a conflict with these dates, please explain below.
Staff Orientation begins at 6:00pm on Friday, May 26th with dinner in the Dining Hall.  Can you arrive on this date?
__________________________________________________________________________________

__________________________________________________________________________________
"7th Session" is a time of “debriefing and fellowship” for our permanent staff after 6th session ends.  It begins upon the departure of our last campers on Friday, August 4th and goes through early morning worship at Crowe's Roost Sunday, August 6th.  Can you stay through this time?

__________________________________________________________________________________

__________________________________________________________________________________

Are you currently CPR (basic)/First Aid certified through the end of the summer?___________________

Are you willing to take any age group you are assigned throughout the summer?___________________

Number in order of preference the age group with which you desire to work as a counselor:
________Grades 5/6		________Grades 7/8		_______Grades 9-13

													2
EDUCATION			
	High School attended and Date of Graduation __________________________________________________________________________________

	College			Dates Attended		Major 			Degree		Date
__________________________________________________________________________________
__________________________________________________________________________________
Camp Experience (as an employee) 
	Name of Camp 		Address		Director		Position	Dates 
____________________________________________________________________________________________________________________________________________________________________
Camping Experience (as a camper) 
	Name of Camp 		Address		Director		Position	Dates 
____________________________________________________________________________________________________________________________________________________________________

Why do you want to return to Camp Blue Haven as a counselor?  ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

What do you consider to be your strongest points as a counselor?  ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

What has been your greatest weakness as a counselor?  ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

What could you do to overcome this weakness?  ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

What do you like the best about the Blue Haven program?  ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

What would you change about the program and why?  ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

													 3

What are your career goals? - __________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________

What are your personal goals for growth in the Lord’s work? - __________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
____________________________________________________________________________________________________________________________________________________________________
What do you perceive to be the greatest needs in the church today? - __________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
____________________________________________________________________________________________________________________________________________________________________
Have your views on any of the following changed since you last worked for Blue Haven?
Salvation___			Grace___
Worship___	                        Baptism____		
If so, please explain:__________________________________________________________________
____________________________________________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________________________________________
__________________________________________________________________________________			
REFERENCES:  Please give three references with complete address and phone number.  Do not include relatives or someone you have already included on this form.

Name ________________________________________________ Phone (        )________________
Address ________________________________________________________________________________
Street or Box # 					City 			State 		Zip

Name _______________________________________________ Phone (        )_________________
Address ________________________________________________________________________________
Street or Box # 					City 			State 		Zip

Name _______________________________________________Phone (        )_________________
Address ________________________________________________________________________________
Street or Box # 					City 			State 		Zip

						

													4

I hereby certify that the responses and information contained herein are being submitted with honesty and a clear conscience.  If selected to be a counselor, I agree to abide by and uphold the rules and purposes of the camp. We will be notifying all applicants of hiring/declining a position sometime in the middle of March, around Spring Break.

____________________________________________________    ____________________________
SIGNATURE								DATE

					Activity Interest/Skills Questionnaire

Please indicate which of the following activities you believe you are qualified to teach, direct, or supervise at camp.  Each counselor will have responsibility for different areas of recreation and evening programs.  
	Arts and Crafts			Individual Sports			Team Sports
______ Nature Crafts			______ Air Riflery			______ Capture the Flag
______ Tin Sculpting			______ Horseshoes			______ Flag Football
______ Wood Carving		______ Badminton			______ Volleyball
______ Leather Work			______ Ping Pong 			______ Basketball
______ Woodburning			______ Archery			______ Mushball
______ Braiding			______ Fishing			______ Softball
______ Painting			______ Frisbee			______ Soccer
	List Others:				List Others:				List Others:
____________________		____________________		____________________
____________________		____________________		____________________

		Music (Check those that you play)			Special Program
	______ Harmonica					______ Large Group Games
	______ Piano					            ______ Group Fun Songs 
	______ Guitar						______ Scavenger Hunts
	______ Fiddle						______ Outdoor Games 
	______ Banjo						______ Indoor Games
	______ Bugle						______ Skits
		List Others:						List Others:				____________________				____________________			____________________				____________________		
		
List Names of Games you would be able to teach or supervise at camp:
		Outdoor Games				Indoor Games 
		For Younger Campers 			For Younger Campers 
		______________________			_____________________
		______________________			_____________________
		______________________			_____________________

		For Older Campers 				For Older Campers 
		______________________			_____________________
		______________________			_____________________