Camp Blue Haven Application
Nurse 

*Must include a current photo

Per Blue Haven policy, all permanent staff must be active members of a Church of Christ.

Print, complete and mail to: Camp Blue Haven, 1020 Austin Ave, Brownwood, TX, 76801
OR  email to: jan@campbluehaven.com (highlight lines, fill in information, save as PDF)

Mark the session you desire to attend. If you are interested in more than one session, number your preferences in order of interest.
	(   ) 1st June 7-13              	 (   ) 2nd June 14-26          	(   ) 3rd June 28-July 4	
	(   ) 4th July 5-17	 	 (   ) 5th July 19-25	    	(   ) 6th July 27-Aug 7

Name _________________________________________________Home Phone _____________________
E-mail Address ___________________________________________Cell Phone _____________________
Address _______________________________________________________________________________
		Street					City		State		Zip
Date of Birth ______________________  Sex:M__ F__
Occupation _____________________________
Present Employer________________________  Contact Person/ Phone ________________________

By whom did you first learn of Camp Blue Haven? _________________________________________
Marital Status__________  Will your spouse be attending camp with you? (   ) Yes    (   ) No 
Spouse Name _________________________________________   *If attending camp, please complete:
E-mail Address ___________________________________________Cell Phone _________________
		Has he/she filled out a VOLUNTEER application?		(   ) Yes     (   ) No

Children Name(s)
	•	A camp registration must be submitted and registration fees sent for each child that will be a camper.  Do not wait until you arrive at camp to do this.  Please be prompt.
	•	Child care is provided only during bible class time.
	•	List name & age at camp time of your children who will accompany you to camp.  
As Campers (List Fall Grade)				Below Camper Age (List Age at camp time)
___________________________________		_________________________________
___________________________________		_________________________________
___________________________________		_________________________________

Have you been baptized into Christ?_______________ 
How many years have you been a Christian?  __________
Are you faithfully attending a Church of Christ? __________ 
*Per Blue Haven policy, session nurses must be active members of a Church of Christ.

Please provide information on the Church of Christ you attend @ HOME:
Name & town _______________________________________________________________________
Preacher's Name__________________________________________Phone______________________
Elder’s Name ____________________________________________ Phone _____________________
Elder’s Name ____________________________________________ Phone _____________________
REFERENCES:   Do not include relatives or someone you have already included on this form.
1. Name ________________________________________________ Phone (      )_________________
Address / Email _____________________________________________________________________
__________________________________________________________________________________
Street or Box # 					City 			State 		Zip

2. Name ________________________________________________ Phone (      )_________________
Address / Email _____________________________________________________________________
__________________________________________________________________________________
Street or Box # 					City 			State 		Zip

3. Name ________________________________________________ Phone (      )_________________
Address / Email _____________________________________________________________________
__________________________________________________________________________________
Street or Box # 					City 			State 		Zip

					SEE SIGNATURE PAGE BELOW

	    ——————————————Signature Page ——————————————

I understand I will be required to provide additional information for a background check in order to volunteer as the camp nurse.					

I understand that I am required to be in camp and “on the job” for the duration of the session including during “Registration”, evening events, half and all day hike days and the middle Sunday of two-week sessions. I will be available at all times to assist.
If hired, I understand that I am expected to obey all camp rules and will be held to a higher standard of behavior as a visible example of Christian service for our staff and campers.  

I agree to follow all the rules of  Camp Blue Haven in conduct and dress code.

I understand that I am to be available at anytime during the session to assist the staff and campers as needed including evenings, half and all day hike days and the middle Sunday of two-week sessions. I will be flexible each day so as to be available to assist when needed. I will attend all camp activities as I am able so I can encourage both staff and campers.

By signing below, I concur that I have received, reviewed and while on Blue Haven Youth Camp, Inc. property and/or participating in Blue Haven Youth Camp, Inc. activities agree to adhere to the following Blue Haven Youth Camp, Inc.'s policies:

Code of Conduct  
Statement of Faith - Marriage & Human Sexuality
Statement of Faith - Abortion
Statement of Religious Authority  

I hereby certify that the information and responses contained in this application are being submitted with honesty and clear conscience.  I also understand that this application does not constitute a contract for employment, and that it will be filed in the Camp Blue Haven office and kept strictly confidential.

___________________________________________________    ____________________________
SIGNATURE								DATE

*Application must include a current photo