camp speaker - campnutimik.com · camp nutimik speaker health report page 1 of 2. this form . does...

CAMP SPEAKER

*All forms become part of your personal file New Applicant Returning Applicant Last Name: ___________________________ First Name: ______________________ Mailing Address: ________________________________________________________ City, Province: ___________________________ Postal Code: ___________________ E-mail: ________________________________________________________________ Phone (h): (_____) _________ (c): (_____) _________ T-Shirt Size: _________(unisex) Church currently serving: _________________________________________________ Name of Lead Pastor/Board Chairman:_______________________________________________ Date of Availability: (Please check all that apply) *Expectation is that you be available for the entire duration of the given camp week unless special arrangements are made with the Executive Director. � Junior 1 (Ages 9-11 – July 7-12

� Middle Years (Ages 11-13 – July 14-19) � Intermediate (Ages 12-14 - July 21-26) � Junior 2 (Ages 9-11 – July 28-Aug 2) � Junior Mini (Ages 7-9 – Aug 6-9) � High School (Ages 14-17 – Aug 11-16) � Waterski Camp (Ages 14-17 – Aug 18-23) Have you worked at camp before or have other related experience? � YES � NO If YES, please share where, when, and in what role (also indicate which age group you prefer or have experience working with) _______________________________________________________________________________________ _______________________________________________________________________________________ On a separate page, please provide a brief personal testimony of your Christian walk and call as well as why you wish to serve at Camp Nutimik in this capacity.

Mail or e-mail to: Camp Nutimik, Box 35040, RPO Henderson, Winnipeg, MB R2K 4J9

(e-mail) [email protected] (website) www.campnutiik.com

Family Information: (Please complete if your family members will be attending with you) Name: ____________________________ Relationship: _______________ Age: _____ Name: ____________________________ Relationship: _______________ Age: _____ Name: ____________________________ Relationship: _______________ Age: _____ Do you or your family attendees have any dietary allergies or needs? Yes No If yes, please provide additional information ________________________________________ ____________________________________________________________________________ References: (please print legibly) Name: ___________________________________ Relationship: ___________________ Mailing Address: ________________________ E-mail address: _____________________ City: ___________________ Prov: ___________ Phone: __________________________ Name: ___________________________________ Relationship: ___________________ Mailing Address: ________________________ E-mail address: _____________________ City: ___________________ Prov: ___________ Phone: __________________________ Name: ___________________________________ Relationship: ___________________ Mailing Address: ________________________ E-mail address: _____________________ City: ___________________ Prov: ___________ Phone: __________________________

Waiver and Conditions of Employment The Executive Director or his designate reserves the right to dismiss a staff member or volunteer who in his/her opinion is a hazard to the safety and rights of others, or who appears to have rejected the reasonable guidelines set for staff conduct (ref. Code of Ethics & Lifestyle). In such event, the individual is responsible for any travel expenses that may result from the dismissal. The applicant certifies that the applicant staff is normal in condition and habits and is amenable to necessary discipline.

While every precaution is taken for the safety and good health of our staff, Lake Nutimik Baptist Camp Inc. o/a Camp Nutimik, its directors, other staff members and other employees of facilities outside of camp property are hereby released from any liability in the event of an illness, accident or misfortune that may occur to the applicant staff. Each staff must be insured by Provincial Health or equivalent medical insurance. The signature of the applicant on this application shall give the Executive Director or Designate or Health Officer the right to arrange for any special services or other requirements necessary for the best interest of the applicant staff and shall give the Executive Director, Designate or Health Officer the right to approve and obtain medical attention necessary for the applicant staff’s welfare and good health including injection, anaesthesia or surgery. The applicant is responsible for any additional expenses that may result from such services. The signature of the applicant on this application shall authorize the appropriate police force to make any investigation of its records and inquiries of other police forces as it may consider appropriate. It also authorizes the said police force to advise Lake Nutimik Baptist Camp Inc. whether or not such sources contain information which in the opinion of the police force may be relevant to this application.

The signature of the applicant on this application shall give the camp permission to use pictures, videos and/or quotes of the applicant for promotional purposes.

Please affirm your agreement with the following statements:

� I have carefully and completely read and agree with the Camp Nutimik Statement of Faith.

� I have carefully read and understand the guidelines as outlined in the Code of Ethics and Lifestyle and will conduct myself in all areas of life and ministry in a manner honoring to God.

� I have carefully read and understand Camp Nutimik’s Harassment/Abuse Policy and do intend to adhere to this policy.

� I will submit a completed health form for myself and all family members attending with me, upon approval of my appointment.

� I will acquire and submit a criminal record check/vulnerable sector search upon approval of my appointment. (*Please note that any family members over the age of 18 attending with you will also require a CRC/VSS check prior to the camp session.)

I have been advised of the responsibilities of my position as Camp Speaker at Camp Nutimik and understand that I am directly answerable to the Executive Director. I further understand and expect no wages or compensation for hours worked. I understand that, only as the Lord enables, the Camp will endeavor to provide an honorarium to help with my expenses. I agree to work in harmony with those around me and to respect the rules, regulations, policies and procedures of Camp Nutimik. I declare that the information contained in this application is accurate to the best of my knowledge and I hereby authorize Camp Nutimik access to information with respect to my person from my reference and Police and Child Abuse registry files. Signature of Applicant: ______________________________ Date: _______________

AFFIDAVIT PERTAINING TO CRIMINAL ACTIVITY

I, , affirm: (Name)

1. That I am of (Full Name) (Address)

2. I am not involved in any criminal activity.

3. I have never been convicted of, nor have any outstanding charges under the Criminal Code of Canada..

4. That I make this Affidavit knowing it will be relied on by Lake Nutimik Baptist Camp Inc. regarding myapplication for employment or to volunteer.

I affirm that the above representations are true and correct to the best of my information,

knowledge and belief.

Date Signature

I, the undersigned witness, do hereby affirm that personally appeared

before me on the day of , 20 and signed the above Affidavit as his/her free

and voluntary act and deed.

Witnessed* by: *Non- family member

(Printed Name) (Signature)

NOTE: Providing false information could lead to immediate termination of employment and criminal charges.

1 Camp Nutimik Job Description – Camp Speaker 4/18/2019

Camp Speaker Job Description

Lake Nutimik Baptist Camp Inc. o/a Camp Nutimik

Position Title: Camp Speaker Reports To: Executive Director Coordination with: Program Director Positions Supervised: None Remuneration: This is a volunteer position for the agreed period and as such

there is no set compensation. An honorarium will be offered as Camp funds allow.

General Overview & Requirements The Camp Speaker is to work closely with the Program Director & Arts Program Coordina-tor. This individual will provide Biblical instruction during formal teaching times and to as-sist in the spiritual nurture and encouragement during the camp week.

Chapel Speaker: Scope of Responsibilities 1. Essential Qualifications2. Organizational Leadership3. Essential Job-Related Functions4. Other Responsibilities

1. Essential Qualifications• A born-again follower of the Lord Jesus Christ as evidenced in word and deed• Recognized by their congregation/home church as having the spiritual gift of

teaching• Ability to relate well with children and youth and able to share Biblical truth in a

contextually relevant manner• Ability to support cabin leaders and others in helping campers begin or

strengthen and grow in their personal relationship with God.

2. Organizational Leadership• Be able to subscribe, without reservation, to the Camp Nutimik doctrinal state-

ment, code of conduct and harassment/abuse policy• Accept and pursue Camp Nutimik’s mission statement, goals and objectives• As a Summer Leadership Team Member, work to nurture a positive camp cul-

ture for all staff, volunteers, and guests.

3. Essential Job-related Functions• Work closely with the Program Director & Arts Program Coordinator in providing

for the spiritual needs of the camp primarily in the area of chapel talks and fire-sides.

• Speak at assigned chapel services and firesides on the theme and topicprovid-ed by the Program Director and in the time allotted. A teaching outlinewill be provided and the expectation is that this will be used as your guide forthe chapels and firesides.

2 Camp Nutimik Job Description – Camp Speaker 4/18/2019

• Use the Bible as the foundation for all teaching times and in all the teaching ma-terial. Keep Biblical content contextually accurate.

• Be committed to prayer in every aspect of your involvement at camp. Providespiritual leadership during the camp and give feedback to the Leadership StaffTeam on issues that may be of ongoing spiritual concern.

• Be familiar with the role of the Camp Speaker in the Camp Nutimik policy per-taining to Missing Camper, Waterfront Emergencies and Evacuation of theCamp.

• Connect with staff and campers outside of formal teaching times (i.e. in morningdevotions with staff and campers) as able and as opportunities arise and pro-vide instruction, encouragement and support as needed.

This job description is not intended, and should not be construed to be an exhaus-tive list of all responsibilities, skills, efforts, or working conditions associated with this job. It is intended to be an accurate reflection of the principal job elements. Other duties may be assigned.

I have read the above job description and understand it, and I believe that I can perform the job as outlined.

Camp Speaker Signature: __ ________ Date:

Executive Director Signature: _______ Date:

Who We Are & Statement of Faith

Camp Nutimik is a distinctly Christian ministry and our mission is to impact children and youth through Biblical teaching and discipleship, to influence Christian character through outdoor experiences and to invest in the development of the next generation of leaders.

Our policies are built on the principles taken from the Holy Bible, the final authority which guides our faith, our actions and our ministry. We require that all Camp Nutimik staff, board members and individuals serving (paid or unpaid) in summer positions believe and follow both our Statement of Faith and our Code of Christian Conduct.

Abbreviated Statement of Faith (Full version is on our website) Camp Nutimik has an understanding and interpretation of Scriptures consistent with the evangelical Christian tradition and maintains a Statement of Faith and Code of Ethics & Lifestyle based on that understanding and interpretation of Scripture.

In summary we believe -

1. The whole Bible is divinely inspired by God and, therefore, our authority for faith and practice.

2. In the One Living and True God, existing eternally in three co-equal persons: Father, Son and Holy Spirit.

3. That Jesus Christ is God, miraculously conceived of the Holy Spirit by the Virgin Mary, revealed God through Hissinless life, miracles and teaching. That He died and was buried and physically rose again, ascended to heavenand will return.

4. In the person of the Holy Spirit who through the Word of God convicts individuals of their sinfulness and of therighteousness of Jesus Christ. He draws humanity to the Savior and bears witness to their new birth. The HolySpirit enables believers to live a holy life, to witness and work for the Lord Jesus Christ.

5. In the existence of angels and demons who are created beings. The holy angels are obedient spirits who bringglory to God. The rebellious angels (demons) along with Satan who is chief among these, are the enemy of Godwho tempt individuals to rebel against God.

6. All people were created in God’s image to have fellowship with Him and to be stewards over His creation.Through sin which entered the world through Adam and Eve, we are all born with a sinful nature and aretherefore separated from God.

7. That salvation of lost and sinful humanity is possible only through the merits of the shed blood of Jesus Christ,received by repentance and faith apart from works and brought into a new relationship as regenerated childrenof God.

8. The Church is the body of Christ and consists of all true believers.

9. That religious liberty, rooted in Scripture, is the inalienable right of all individuals to freedom of conscience withultimate accountability to God.

10. That Christians individually and collectively, are salt and light in society. In a Christ-like spirit, they oppose greed,selfishness and vice; they promote truth, justice and peace; they aid the needy and preserve the dignity ofpeople of all races and conditions.

11. That the Bible teaches that marriage refers to the covenant relationship between one man and one woman, asinstituted by God in the beginning, to the exclusion of all others. We affirm the family as the basic unit ofsociety and seek to preserve its integrity and stability.

12. In the personal and literal return of the Lord Jesus Christ in God’s own time to judge the living and the dead andbring all things to their appropriate end and establish a new heaven and a new earth.

Code of Ethics & Lifestyle

In our ministry roles as Christian leaders of children and youth we are held to higher standards of behavior. The goal of our code of conduct is to honor one another, to avoid the very appearance of evil, to avoid creating a stumbling block for fellow staff or campers, and to be Christ-like role models to the children and youth within our influence.

Staff members are expected to conduct themselves, both at work and away, in a manner that will enhance, not discredit, the Lord and the work of Camp Nutimik. Furthermore, a breach of the Code of Conduct, Statement of Faith, or the Harassment and Abuse policy is grounds for, and may result in, dismissal.

The following policies have been approved by the Camp Nutimik Board of Directors, on various matters of staff conduct:

CONDUCT WITH OUR CAMPERS

Staff should always avoid situations with children and youth which could in any way be misconstrued as being indiscreet. Staff should generally build their closer relationships with children and teenagers of the same gender; likewise, private counseling situations with the opposite gender should generally be avoided. There is an increasing sensitivity about staff expressing concern for youth in any physical way whatsoever, and there are an increasing number of cases where such affection has been misunderstood. Therefore, indoors or out-of-sight counseling situations should be avoided whenever possible, and if deemed necessary within the discretion of the cabin leader, a third person, i.e. another cabin leader, should be invited to sit in on a session. It is best that all “counseling” sessions take place in a highly visible area, yet offering adequate privacy.

STAFF DRESS CODE

Clothing must be modest and a reflection of our testimony as a follower of Christ. It is our expectation that modest and appropriate dress becomes a lifestyle, not just rules followed during the camp program.

Swimwear shall be worn at the beach or beach volleyball court only and not on the grounds while engaged in any activities other than returning to your cabin to change, unless deemed appropriate by the Program Director for special camp activities.

At the waterfront, modest swimwear is required. One-piece swimwear is preferred for girls, but if this is not possible, at least a top will be required to be worn over the bathing suit. Guys should wear a shirt on the grounds (excluding the waterfront) unless authorized by the Program Director for special camp activities.

We require that shorts be at a minimum hand width inseam and a minimum guideline for skirts is that it extends beyond the fingertips when one's hands are at their side. If you are in doubt about an item, do not bring it to camp.

Bare feet and wet footwear are not permitted

in the dining hall. Socks or dry shoes/sandalsmust be worn past the entry way. No open-toed or water footwear may be worn when working in the kitchen.

Clothing with questionable or inappropriate symbols and/or words shall not be worn. Administrators have the right to ask a staff to not wear clothing items if deemed inappropriate for reasons other than those listed.

Hats are not permitted to be worn in the Chapel for sessions or worship related activities.

We require staff to wear their staff shirts on the first and last day of each camp session or as directed by the Program Director.

SUBSTANCE ABUSE

We require that our lifestyle as Christ followers accurately reflects consistency and commitment to keeping our lives pure and not be a stumbling block for others. It is required that all staff abstain from—and not encourage—behaviour contrary to biblical principles, including but not limited to: smoking, use of alcohol, recreational marijuana, illegal substances reading or viewingof pornographic material. Any use of these products while onsite, drunkenness and intoxication (in public or private) is grounds for immediate dismissal.

LIVING ARRANGEMENTS

Unmarried staff must not share over-night accommodations with others on a co-ed basis at any time or anywhere while serving in the Camp Nutimik spring or summer ministry. Such behavior will be grounds for dismissal. It is our policy that at no time will staff of the opposite sex be in each other’s rooms.

MOVIES, MUSIC AND OTHER MEDIA

All media on Camp Nutimik property must meet with the approval of the Board of Directors or its designates. On or off-site movies that are G or PG may be viewed without permission. PG-13 and higher rated movies must be authorized by the Program Director before viewing.

We recognize that music is diverse and the “Christian Music” label can be vague; defined and interpreted differently by each individual.

Music that is played on site must be Christian in the definition that it honors God and is in line with the morals and teachings of scripture or it be strictly musical in nature. If music is questioned, the Program Director or designate will look at the message, lyrics, context and integrity of both the music and the artist before permitting the music to be played. Be considerate of each other’s genre and volume preferences.

It is recognized that individuals are able to listen to their own music in the privacy of their headphones, own room or vehicle. Personal music may be prohibited or privileges restricted if the music is deemed offensive in any way.

Use of personal electronics including cell phones is restricted and should not be used without prior approval by the Program Director or Assistant Program Director.

SEXUALITY

In accordance with our statement of faith, any sexual activity between and involving individuals outside of a heterosexual, monogamous marriage relationship is strictly prohibited and will constitute grounds for dismissal. This includes, but is not restricted to, pre-marital sex, extra-marital sex and homosexual activity.

OTHER

Camp Nutimik also prohibits – gambling, involvement in sectarian or cult groups, abortion or support of organizations promoting abortion; racist conduct or language; the use of profane or blasphemous language; and behavior contrary to the Criminal Code of Canada. Any violation of any one of the above as interpreted by the Camp Board of Directors and its’ designates may result in immediate dismissal.

CONCLUSION

Where there is a breach of the Code of Conduct, whether it results in dismissal or not, the overriding goal of Camp Nutimik shall be redemptive – seeking acknowledgment of wrong doing, repentance and restoration of broken or damaged relationships.

Revised – May, 2018

Harassment & Abuse

At Camp Nutimik, we are committed to a policy of providing and maintaining a positive work environment, free of both sexual and

general harassment and abuse. Harassment and abuse are forms of employee misconduct which are demeaning to another person,

which undermine the integrity of the employment relationship, and are strictly prohibited.

Pranks and practical jokes have been ruled as being “potential” harassment and so the policy at Camp Nutimik will be that they will

be allowed with the following stipulations:

• they do not involve loss of sleep, damage, happen in or around staff housing and do not cause embarrassment

• they are done in a healthy spirit and only to those who share in the amusement of pranks; those who do not like them are

to be avoided and are expected not to participate themselves in the implementation of a prank

• they must be cleared by the Program Director or the Executive Director

The Human Rights Code of Manitoba (HRCM) defines “Harassment” as follows:

1. A course of abusive and unwelcome conduct or comment based on someone’s nationality, ancestry or ethnic background,

religion, age, gender, sexual orientation, marital or family status, source of income, political belief, or physical or mental

disability;

2. A series of objectionable and unwelcome sexual solicitations or advances; or

3. A sexual solicitation or advance made by a person who is in a position to confer upon or deny any benefit to the recipient;

and

4. A reprisal or threat of reprisal for rejecting a sexual solicitation or advance.

Specifications that can be considered harassment include, but are not limited to the following:

1. Unwelcome remarks, actions, jokes, or comments relating to an individual's nationality, sex, etc.;

2. Unwelcome remarks, actions, jokes, or comments relating to an individual's body, attire, appearance or weight;

3. Verbal abuse or threats;

4. The displaying of pornographic, racist or other offensive or derogatory pictures;

5. Practical jokes which cause awkwardness or embarrassment;

6. Unwelcome sexual invitations or requests, whether indirect or explicit;

7. Intimidation;

8. Leering or other gestures;

9. Condescension or paternalism which undermines self-respect;

10. Unnecessary physical contact such as touching, patting, pinching, punching; and

11. Physical abuse or assault.

If an employee feels she or he is the subject of conduct which is harassing, she or he should clearly state to the source of the

harassment that the conduct is unwelcome. While this response is recommended generally, all concerns and complaints will be dealt

with regardless whether such a statement is made. An employee who wishes to report an incident of sexual and/or general

harassment or abuse should promptly report the matter to his or her immediate supervisor. If the supervisor is unavailable or the

employee believes it would be inappropriate to contact the supervisor, the employee should immediately contact the Executive

Director. Employees may raise concerns and make report without fear of reprisal, and concerns and complaints will be treated in

confidence except as necessary for the purpose of investigation and subsequent remedial action. No record of having made a

complaint will be entered on to the employee’s personnel file, but a record will be kept in a separate confidential file.

Employees are reminded that harassment is an offense under The Human Rights Code of Manitoba, and that an employee who is

the victim of harassment has the right to file a complaint with the Human Rights Commission.

Anyone who becomes aware of possible sexual and/or general harassment or abuse should promptly advise the Executive Director,

who will handle the matter in a timely and strictly confidential manner. If a supervisor or manager is aware of possible harassment or

abuse and does not act upon the situation accordingly, he or she will be subject to appropriate disciplinary action. Under no

circumstances should a complaint be dismissed or down played or the complainant told to deal with it him or herself.

The Executive Director or a designate shall investigate any allegations of harassment or abuse and all affected employees shall be

afforded a full opportunity to be heard with or without assistance from a representative of their choosing. The Executive Director or

designate will attempt to resolve the matter and all affected employees will be informed of the result of the investigation.

The Executive Director shall determine the appropriate action to be taken following the investigation. Anyone engaging in sexual

and/or general harassment or abuse will be subject to disciplinary action, up to and including termination of employment. This policy

applies to all employees of Camp Nutimik, including management personnel.

As stated above, Camp Nutimik is committed to a policy of providing and maintaining a positive work environment and anyone

having questions with respect to this policy is invited to contact the Executive Director for further information.

Revised - December 15, 2011

Camp Nutimik Speaker Health Report Page 1 of 2

This form DOES NOT need to be completed by a physician.

CAMP SPEAKER HEALTH REPORT – 2019-PLEASE PRINT-

First Name Last Name

Mailing Address

Postal Code Age Date of Birth Phone # ( )

Personal Medical # (9 Digits) Registration # (6 Digits)

Other Medical/Accident Insurance Type & No.

In Case of Emergency:

First Name Last Name

Home # ( ) Work # ( )

Alternate Contact Person Phone # ( )

General Health History (List any): Indicate Treatment (i.e. give Tylenol, rest, etc.) Chronic Illness (i.e. diabetes, arthritis) Psychological conditions (i.e. ADD, behavioural concerns, phobias, depression)

Neurological conditions (i.e. epilepsy, migraines, frequent headaches)

Eye problems (i.e. pink eye, wears glasses / contacts) Ear, Nose and Throat problems (i.e. ear aches, sinusitis, sore throat) Mobility Limitations

Orthopedic Injuries/problems (i.e. joint or back injuries) Respiratory problems (i.e. frequent colds or coughs) Asthma (what triggers an attack?)

Gastrointestinal problems (i.e. stomach aches, nausea, vomiting, constipation) Skin conditions (i.e. rashes, eczema, hives, burns easily in the sun) Past Surgeries

Other

Are there any other medical conditions the Camp Health Officer should be aware of? Yes No (If yes, please specify)

__________________________________________________________________________________________________________________

__________________________________________________________________________________________________________________

Date of last Tetanus shot ______________________

Are Immunizations up to date? Yes No

Camp Nutimik Speaker Health Report Page 2 of 2

HEALTH REPORT 2019 CONTINUED Name:

Allergies Please list any allergies to food (e.g., lactose intolerance), medication or other allergies (such as pollen, dust, etc.):

Allergy

_____________________________________________

_____________________________________________

_____________________________________________

_____________________________________________

Reaction

_____________________________________________

_____________________________________________

_____________________________________________

_____________________________________________

Treatment (e.g. Epipen)

_____________________________________________

_____________________________________________

_____________________________________________

_____________________________________________

Medications Please list the medications you are currently taking:

Name of Medication Dose Time usually taken Reason

_______________________________________________________________________________________________________________________________

_______________________________________________________________________________________________________________________________

_______________________________________________________________________________________________________________________________

_______________________________________________________________________________________________________________________________

_______________________________________________________________________________________________________________________________

_______________________________________________________________________________________________________________________________

_______________________________________________________________________________________________________________________________

Please note: All prescribed medication must be kept in a safe location during your time at Camp Nutimik.

If you have been exposed to an infectious disease or serious illness within the past six weeks, or have had a medical problem, please have your doctor send a letter to Camp Nutimik outlining the illness, physical activity restrictions and medications prescribed.

NOTE: In the event of serious illness, accident, or other emergency, your emergency contact will be contacted. In the event that I am unable to give my verbal consent during such emergency, I hereby give consent for the camp administration to arrange for professional medical treatment in the event of an emergency. In the event medication, medical advice, treatment, ambulance, and or equipment are required, I agree that all charges will be my responsibility.

Staff Signature _________________________________________________________ Date _______________________________________

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Reference Form

*This form is to be completed by the applicant's reference and is to be submitted to Camp Nutimik by the reference.*

APPLICANT INFORMATION: (complete this section before giving the form to your reference)

has submitted an application for the position of . Your candid opinion and firsthand knowledge of the criteria below will help us evaluate the applicant's eligibility for his/her employment in Christian camping ministry to children and teens at Camp Nutimik.

Waiver Statement: I authorize the release of the disclosed information by the person completing this reference form, and waive any right or privilege to inspect or challenge its contents. I understand that this information will be held in strict confidence by the administrative employees of Camp Nutimik and that it will not be released to anyone without my permission, except when such disclosure is required by law.

Signed: Date:

Signature of parent/guardian if applicant is under 18 years of age:

REFERENCE FEEDBACK: How long have you known the applicant? In what capacity? How well do you currently know the applicant? □ Casually (few personal contacts) □ Fairly well (numerous contacts) □ Very close relationship

Please choose the best description of the applicant's Christian commitment: □ Obvious strong personal commitment to Jesus Christ □ Struggling commitment to their faith

□ Exhibits fairly consistent desire for maturing their faith □ Poor example of the Christian faith

Comments:

What degree of interest does the applicant display in church life? □ Enthusiastically engages in church activities for his/her age group or any age

□ Is cooperative and usually willing to help in the various activities of the church

□ Seldom participates in church activities, although regularly attends

□ Is very irregular in church attendance and shows little interest in activities

□ No basis for judgment

How would you describe the applicant's ability to relate and communicate with children or youth?

Does the applicant have any habits or traits that you know of, that may disqualify him/her to work at a camp? □ Yes □ No

If yes, please explain:

What kind of influence would the applicant have on his/her co-workers? □ Positive □ Neutral □ Negative

Would you entrust your child to the applicant's care at camp? □ Certainly □ Yes, but with apprehension □ No

PLEASE RATE THE APPLICANT IN EACH CATEGORY:

Spiritual Motivation □ Excellent high degree of pursuit and passion

□ Good generally pursues growth with passion

□ Fair responds with desire when challenged

□ Poor shows no or minimal desire to grow

□ N/A no basis for judgment

Emotional Stability □ Excellent exceptionally stable and consistent

□ Good well balanced, stable in most situations

□ Fair manageable share of highs and lows

□ Poor □ excitable □ depressive


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Peer Sociability □ Excellent thrives in all social environments

□ Good succeeds in most situations

□ Fair survives; depends upon the context

□ Poor generally struggles in relating to peers


Health □ Excellent rarely ill or injured; fit and energized

□ Good generally fine; decent fitness and energy

□ Fair periodic illnesses or injuries, can keep up

□ Poor often ill, accident prone, tires easily


Maturity of Judgment □ Excellent consistently wise or fair

□ Good usually makes sound decisions

□ Fair inconsistent with good sense

□ Poor □ hasty □ indecisive


Cooperation □ Excellent works very well with others; considerate

□ Good usually considerate and sensitive

□ Fair cooperates when convenient

□ Poor tends to be difficult with others


Work Ethic □ Excellent consistently gives extra effort

□ Good generally a hard, thorough worker

□ Fair works enough to get by

□ Poor lazy


Quality Control □ Excellent very diligent and dependable

□ Good generally follows through well

□ Fair follows through when convenient

□ Poor needs closer monitoring


Integrity □ Excellent consistently trustworthy

□ Good generally honest and true

□ Fair may obscure the facts

□ Poor questionable character


Teamwork □ Excellent a joy to work with

□ Good contributes positively

□ Fair neutral, minimal contribution

□ Poor difficult, often negative contribution


Leadership □ Excellent a leader of leaders

□ Good generally influential and positive

□ Fair can and will lead when called upon

□ Poor □ passive □ disruptive/corruptive


Ability to Follow □ Excellent takes instruction and correction well

□ Good generally cooperative with supervisors

□ Fair will comply begrudgingly

□ Poor can be disrespectful and/or disruptive


Initiative □ Excellent looks for things to be done

□ Good regularly does what needs to be done

□ Fair does the obvious, bare minimum

□ Poor usually needs to be prodded


Flexibility □ Excellent adapts quickly, remains positive

□ Good generally open-minded and adaptable

□ Fair needs some time to adjust

□ Poor can get ruffled and upset w/o routine


Creativity □ Excellent ingenious, spontaneously, imaginative

□ Good holds many creative ideas

□ Fair can do well with help from resources

□ Poor struggles coming up with ideas


Ability to Work Under Stress □ Excellent thrives, remains pleasant and productive

□ Good usually amiable and productive

□ Fair survives with moderate success

□ Poor □ irritable □ panicky


□ I would like to discuss the applicant with you further

REFERENCE INFORMATION: Name:

Relationship to applicant:

Phone #: ( ) □ home □ cell □ work Best time to call: □ AM □ PM

Signature: Date:

Please mail, fax or e-mail to: Camp Nutimik, P.O. Box 35040, RPO Henderson, Winnipeg, MB R2K 4J9 (fax) 204-348-3461

(email) [email protected] (website) www.campnutimik.com

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