Kawkawa Camp and Retreat, Hope BC | Volunteer Application

First Name *

Last Name *

Male/Female *

Your Unique Camp Name

Date of Birth *

Today's Date *

(auto)

Age *

(auto)

Address *

City *

Postal Code *

Email Address *

Primary Phone *

Alternate Phone

T Shirt Size

Care Card Number

Emergency Contact *

Phone *

How / where did you hear about Kawkawa? *

Areas of Interest *

Please list any special licenses, certifications, or qualifications *

i.e. WSI . NLS, RN, CPR, 1st Aid, Food Safe, Life Guard, Driving License, Boaters License, etc

Starting Available Date *

Last Available Date *

Church Affiliation (if any) / Attending, and for how long? *

How do you want to contribute to camp life? *

Personal References

Please include names, phone contact and email address of 3 references we can contact. Try for one pastoral, one adult friend and one teacher / employer.

Reference 1: Name / Phone / Email *

Reference 2: Name / Phone / Email

Reference 3: Name / Phone / Email

Are there circumstances or traits in your lifestyle or background that would call into question your ability to work with children or youth? *

Yes

No

Have you ever been arrested or convicted for the use or sale of drugs? *

Yes

No

Have you ever been hospitalized or treated for alcohol or substance abuse? *

Yes

No

Have you ever been convicted of a criminal offense? *

Yes

No

Do you have any pending criminal charges or convictions? *

Yes

No

Have you ever been accused, arrested/convicted for any abuse-related crimes? *

Yes

No

Have you ever been the subject of any disciplinary action (including discharge) or investigation by a church, religious or other organization, or by an employer? *

Yes

No

Do you have any physical condition which would limit your capacity for the job(s) applied for or health concerns of which we should be aware? *

Yes

No

Do you have any type of special diet? *

Yes

No

If you have answered “yes” to any of the above questions, please explain. *

Personal Consent

I agree to my picture being used by Kawkawa Camp & Retreat for program, promotional & publicity purposes. *

Yes

No

I agree to consent to a Police Criminal Record Check and will have this delivered to the camp prior to my arrival on the camp property.

Yes

No

To the best of my knowledge, all information which has been given in this form or during any interview, is accurate and complete. I understand that in the event of my application being accepted by Kawkawa, I shall be subject to dismissal if any of the information I have given is false or if I failed to give any material information herein requested. *

Yes

No

Signature *

Clear

Volunteer Application Form

Personal References

Personal Consent

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