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GREAT RIVER REGIONCAMP AND CONFERENCE

INFORMATION PACKET 2015

GREAT RIVER REGIONCAMP AND CONFERENCE


GREAT RIVER REGION CAMP AND CONFERENCE


GRR Camp & Conference 2


GREAT RIVER REGION

CAMP AND CONFERENCE INFORMATION PACKET 2015

WELCOME TO SUMMER 2015! The Great River Region (GRR) is excited you are making plans to join us this summer for one of our amazing camping experiences. We are grateful to all those who are willing to participate in a leadership capacity and share their love of Christ with others. We are thankful for all of the Children and Youth interested in attending Camp and growing in their faith. We are truly blessed in our Region! Please reach out to the regional office (501-562-6053) or Alisha Gourley, Youth Coordinator at 479-202-3200 (call/text) or [email protected] with any questions. Information Packet Overview Please carefully review the following information and documents as this Camp and Conference Information Packet includes details for Youth, Parents, Youth Pastors, Churches and Volunteers so not all of the information will be relevant to everyone’s specific Camp and Conference needs. Within this Information Packet you will find registration forms for Campers along with applications for our Youth and Young Adult Leadership opportunities and Camp Counselor application. All Camp and Conference Registration Forms and Youth and Adult Counselor Applications are due into the Great River Region office by Friday, May 15. Camp Fees The Total Camp Fees listed below are the Camp Fees due to the Great River Region to cover all associated Camp fees noted below. Please note some of our Church congregations are able to provide scholarships or pay partial Camp Fees so please be sure to reach out to your Youth Director, Youth Pastor, Church Pastor or Church Office for more information. Please note steep late fees assure adequate food, housing and adult supervision for our GRR Campers.

Camp Camper Eligibility (Completed) Dates Location Total

Camp Fee Total Camp Fee

AFTER 5/15 Discovery K-2nd June 13 - 14 Camp Couchdale $90 $115 JYF 3rd - 5th June 14 - 17 Camp Couchdale $210 $235 Chi Rho 6th - 8th June 17 - 21 Camp Couchdale $260 $285 CYF 9th - 12th June 21 - 26 Camp Couchdale $375 $400 Magnolia 3rd - 12th June 22 - 27 Roosevelt State Park $140 N/A

REQUIRED – If your camper should have to go to the hospital, your signature as parent/guardian on camper registration forms MUST be original – fax copies, photocopies, etc are not accepted by the hospital – please be sure to sign where indicated and send the original forms to the regional office.


Camp and Conference Information Packet: Table of Contents

Camp Details and Registration Forms Camp General Information Page 5 Camp Schedule and Packing List Page 6 Discovery Camp Information Page 7 JYF and Chi Rho Camp Information Page 8 CYF Conference Information Page 9 Camp Couchdale Directions and Map Page 9 Magnolia Camp and Conference Information Page 10 Camper Registration Form (Discovery, JYF, Chi Rho; CYF Conference) Page 11 – 14 Youth Leadership: Counselor In Training (CIT) Details, Application and Registration Forms Youth Counselor-In-Training (CIT) Info Page 15 Youth Counselor-In-Training (CIT) Application Page 16 Youth Counselor-In-Training (CIT) Registration form Page 19 – 20 Background Screening Consent and Information Form Page 21 – 22 Young Adult Leadership: Summer Intern Details, Application and Registration Forms Summer Intern Info Page 17 Summer Intern Application Page 18 Background Screening Consent and Information Form Page 21 – 22 Adult Leadership: Counselor Application and Registration Forms Counselor Registration Form Page 19 – 20 Background Screening Consent and Information Form Page 21 – 22


GRR Camp General Information • Prayers: Your prayers matter and we thank you in advance for praying for the spiritual growth and

physical safety of our Campers and Staff. Please pray for our Staff as we prepare for this summer’s Camps and continue praying during each Camp.

• Camp Staff: Each Camp will be Co-Directed by two adult leaders dedicated to the well-being and spiritual journey of our GRR Campers. In addition, our GRR Youth Coordinator will be at each Camp. All adult counselors are carefully selected and screened to ensure the best experience for our Campers.

• Youth Leadership: We will have Counselors-In-Training (CIT) during Discovery and JYF Camp this summer. If you have a youth 16 and older who is interested in becoming a CIT, please be sure to complete the CIT application and submit directly to the GRR office by May 15.

• Youth Adult Leadership: We will have two Interns attending all four Camps (Discovery, JYF, Chi Rho and CYF) this summer. Interested high school graduates (2014 or earlier) may submit their application (for a four-week Camping Season internship) directly to the GRR office by May 15 for consideration.

• Health Screening: All Campers will be subject to a health check upon arrival at Camp. If a Camper arrives with head lice or fever, the Camper will not be allowed to participate in Camp and sent home.

• Medications: It is important GRR receives advanced notice if your Camper will be taking medications during Camp. A Medications Form will be provided for Parents/Guardians to complete and send with their Camper along with the medications to be dispensed during Camp.

• Swimming: Each Camp (except Discovery Camp) will have daily swim times. We have alternative activities available during all swim times for those Campers who would rather not swim. If your Camper is not a swimmer or prefers not to swim, please be sure to indicate on Registration Page 2.

• Transportation to Camp: Please inquire with your Church about transportation as many Churches provide travel to and from Camp. If your Church is unable to provide transportation, please reach out to our Youth Coordinator at [email protected] or contact the GRR office for assistance.

• Camper Registration Form: Please be sure to thoroughly complete all four pages of the Camper Registration Form. The information provided for your Camper enables our Camp Staff to adequately prepare for Camp and make arrangements as needed to best meet the needs of our Youth. Please be sure Camper contact information is current as follow up confirmation and Camp information will be provided prior to the start of each Camp. For Insurance purposes the ORIGINAL Registration Form is due IN THE REGIONAL OFFICE PRIOR TO CAMP START. ALL camper forms are kept on file in the regional office for legal purposes.

• Camp Fees: Camper Registration Fees cover the cost of our Camp Site, Counselors, Directors, Nurse, Life Guard, Insurance, Meals, Snacks, Camp T-Shirt and Supplies (First Aid, Leader Guides, Activities, Crafts, Nametags, etc.) along with Honorariums for our Musicians and Keynote Speakers. Please be sure to follow up with your Pastor or Church Office as many Churches offer scholarships or provide funds towards Camp fees.

• Camper Registration Submission: Please note the Camper Registration Form and all Camp Fees noted in this Information packet are due IN the Great River Region Office (9302 Geyer Springs Road, Little Rock, AR 72209) by Friday, May 15.


Camp Schedule Below you will find an example of a daily Camp Schedule to give you an idea of what your Camper’s day will entail. Please note each Camp will vary based on the needs of the Camp and specific activities. Please note as Discovery Camp is an overnight Camp their schedule will vary from the sample Camp Schedule below.

7:00 AM Wake Up 7:55 AM Breakfast Prayer 8:00 AM Breakfast 8:30 AM Clean Up 9:00 AM Gathering: Announcements, prayer, energizer, music, keynote 9:45 AM Small Group Morning Rotation 11:30 AM Clean Up for Lunch 11:55 AM Lunch Prayer 12:00 PM Lunch 12:30 PM Lunch clean up 1:00 PM Horizontal Time 2:00 PM Canteen 2:30 PM Pool or Movie/Craft 4:00 PM Afternoon Activity 4:55 PM Dinner Prayer 5:00 PM Dinner 5:30 PM Clean Up 5:45 PM Gathering: Announcements, energizers, music, keynote 6:15 PM Small Group 7:00 PM All Group Activity 8:00 PM Clean Up 8:30 PM Snack 9:00 PM Worship 9:30 PM In Cabins 10:00 PM Lights Out

Camp Packing List Below is a list of items each Camper will need to bring to Camp:

� Bible and Notebook � Money for Offering and Canteen � Bedding (Sleeping Bag/Twin-Sized Bedding; Pillow) � Toiletries (Shampoo, Soap, Deodorant, Toothpaste, Toothbrush, Hairbrush/Comb, etc.) � Modest Summer Clothes (enough for the duration of Camp) and Modest Swimsuit � Shoes including water shoes (flip-flops) AND Closed-Toe Shoes (hiking/outdoor activities) � Rain Jacket, Sweatshirt and Long Pants (in case of rain and/or colder weather) � Towels (for bathing and swimming) � Water Bottle � Flashlight � Sunscreen and Bug Spray


Discovery Camp Camp

Camper Eligibility Camp Dates Camp Location

Forms Due to Region

Total Camp Fee by 5/15

Discovery Completed K-2nd June 13 – 14 Camp Couchdale in

Hot Springs May 15 $90

Camp Overview Discovery Camp is an overnight introduction to the Great River Region Church Camp program and is geared towards parents/grandparents to attend alongside their Youth. Parents will see first-hand what Church Camp is all about as they experience this high-energy camp through activities, fellowship and worship with their Youth. Discovery Camp staff includes Co-Directors, Youth Coordinator, Young Adult Interns and Counselors in Training however we do not have additional Counselors at this Camp. We rely heavily on our Campers parents and grandparents to help and participate in Camp activities and of course join in on all the fun and fellowship. Our Discovery Camp theme this year is Power UP! Living in the Spirit! Please note it is preferred each Camper has a parent/grandparent attend however if a parent/grandparent is not available the Church is required to send adult sponsors of the same gender for each Camper. If this presents an issue for one of your Campers, please reach out to Alisha and/or the Regional office to see if we can help. Camp Leadership Sarah Dowd, FCC Monroe, LA is returning as Director & Jeremiah Griffin, FCC Fayetteville, AR is returning as Music Director.

Camp Schedule Sample Saturday 1:00 PM Registration 1:30 PM Singing/Parents Meeting 2:00 PM Craft 2:30 PM Change into swimsuits 2:45 PM Water Games 3:30 PM Snack 3:45 PM Change into clothes 4:00 PM Singing and Lesson #1 4:30 PM Activity Stations: worship, games, crafts 5:00 PM Dinner 5:45PM Singing and Lesson #2 6:30 PM Craft 7:00 PM Nature Walk/Tour the camp 8:00 PM Worship 8:30 PM Campfire and S’mores 9:00 PM Off to Cabins 9:30 PM Lights Out Sunday 7:30 AM Wake up/Pack Up 8:30 AM Breakfast 9:15 AM Craft 9:45 AM Singing/Lesson/Closing


JYF Camp (Junior Youth Fellowship) Camp


Forms Due to Region


JYF Completed 3rd - 5th June 14 – 17 Camp Couchdale in

Hot Springs May 15 $210 Camp Overview JYF Camp is four days and three nights and jam-packed with activities including crafts, water games, swimming, keynote sessions and small group sessions. Campers will also take an active role in daily worship. Our JYF Camp theme this year is Power UP! Living in the Spirit! Camp Leadership Renee Eakin, KHCC Shreveport, LA and Yvonne Taylor FCC Baton Rouge, LA are both returning to Camp and will be Co-Directing JYF. Jeremiah Griffin, FCC Fayetteville, AR is returning as Music Director.

Chi Rho Camp Camp


Forms Due to Region


Chi Rho Completed 6th – 8th June 17 -21 Camp Couchdale in

Hot Springs May 15 $260 Camp Overview Chi Rho Camp extends the youth camping experience to five days and four nights. Youth will be kept busy participating in crafts, water games, swimming, keynote sessions, small group sessions and Youth-led worship. Campers will also have down time, an opportunity to go on a nature hike and have a Camp Dance. Our Chi Rho Camp theme this year is Power UP! Living in the Spirit! Camp Leadership Cody Robertson, FCC Bentonville, AR and Betty Arambel, FCC Fayetteville, AR will be Co-Directing Chi Rho.


CYF Camp (Christian Youth Fellowship) Camp Camper Eligibility Camp Dates Camp Location

Forms Due to Region


CYF Completed 9th – 12th June 21 – 26 Camp Couchdale in

Hot Springs May 15 $375 Camp Overview CYF Conference is a week-long Camp that provides Campers an opportunity to build true community. Activities include swimming, keynote sessions, small group sessions, Youth-led worship along with our annual traditions including Counselor Fashion Show, Dance and memorable Senior Walls. Camp Leadership Ronny Nowell, FCC Rogers, AR will be returning to CYF Conference this year alongside Mike Jennings, Park Hill Christian Church, AR to Co-Direct together. Camp Couchdale Location and Directions Camp Couchdale (map below) 301 Catherine Park Road Hot Springs, AR 71913 501-262-1326

Directions to Camp Couchdale, Hot Springs, AR From Arkadelphia: Take I-30 East toward Malvern. Take exit 97, follow Hwy 171 West approximately 8 miles—watch for Camp Couchdale sign, turn LEFT. From Hot Springs: Take Hwy 270 (toward Malvern) approximately 2 miles. Turn RIGHT on Carpenter Dam Road (Hwy 128), crossing the bridge below the dam. Take Hwy 290, bear LEFT and follow to Hwy 171, turn LEFT. Go approximately 1/2 mile. Watch for Camp Couchdale sign, turn LEFT. From Little Rock: Take I-30 West toward Malvern (approximately 43 miles). Take exit 97, follow Hwy 171 West approximately 8 miles—watch for Camp Couchdale sign, turn LEFT.


Magnolia Camp & Conference Camp Camper Eligibility Camp Dates Camp Location Camp Fee

Magnolia Completed 3rd - 12th June 22 - 27 Roosevelt State Park $140 Camp Overview Magnolia Camp and Conference is designed for Campers to have an encounter with the Bible through exploring scriptures, drama, crafts, story-telling and hands-on exploration. Our Camp theme this year is Power UP! Living in the Spirit! Camp Leadership Jose McClorine from Port Gibson, MS has been sharing her God-given talent to love our Youth for over 40 years and is returning again this summer alongside sponsors Yevorne Bridges, Pamela Dubose, Elder Columbus Felton, Anita Shorter, Janice Smith and Artie Stewart. Camp Packing List Bible, Writing Tablet, Pencil/Ballpoint Pen, Robe/Pajamas, Heavy Spread/Comfort or Blanket, Twin Bed Sheets, 8 Bath Towels and Wash Cloths, Big Towel for Swimming, Swim Wear, Church attire for Friday night, Play-Clothing and Casual Wear for 6 days, Toiletries (Soap, Toothbrush, Toothpaste, Deodorant, etc.). Do NOT bring your radio, CDs, CD Player or Boom Box to Camp. Camp Contact Any Camper or Conferee who brings a cell phone to Camp will turn over the phone to Mrs. Josie or one of the Directors upon notifying parents they have arrived safely to Camp. Parents if you wish to contact your Camper please call Mrs. Josie at 601-415-1762 or contact your Church’s adult sponsor attending Camp (if applicable).

Roosevelt State Park Location & Directions Directions to Roosevelt State Park, Morton, MS:

2149 Highway 13 S. Morton, MS From Lake Charles: Take I10 E to I12 E to I55 N to I-20 East. Take the MS-13, Exit #77, toward Morton/Puckett. Turn RIGHT onto MS-13 North/MS-13 Bypass SOUTH. Continue to follow MS-13 North. From Jackson: Take I-20 East via Exit #94. Take the MS-13, Exit #77, toward Morton/Puckett. Turn RIGHT onto MS-13 North/MS-13 Bypass SOUTH. Continue to follow MS-13 North. From Meridian: Take I-20 West toward Laurel/Jackson. Take the MS-13, Exit #77, toward Morton/Puckett. Turn RIGHT onto MS-13 North/MS-13 Bypass SOUTH. Continue to follow MS-13 North.


GRR Camper Registration Form: Page 1/4 Camper Registration Forms with Camp Fee are due into the Great River Region Office by May 15.

Great River Region Camper Registration 9302 Geyer Springs Road, Little Rock, AR 72209

Please Check One

Camp Camper Eligibility (Completed) Dates Camp Location


Total Camp Fee AFTER

5/15

Discovery K-2nd June 13 - 14 Camp Couchdale $90 $115

JYF 3rd - 5th June 14 - 17 Camp Couchdale $210 $235

Chi Rho 6th - 8th June 17 - 21 Camp Couchdale $260 $285

CYF 9th - 12th June 21 - 26 Camp Couchdale $375 $400

Magnolia 3rd - 12th June 22 - 27 Roosevelt State Park $140 N/A

Check One Participant T-Shirt Size

(YS, YM, YL, S, M, L, XL, 2X; 3X)

Female Youth Camper

Male Youth Camper Adult Participant (Discovery Camp Only)

Please print clearly and thoroughly complete all of the following information: Camper First Name: _____________________ Camper Last Name: _____________________ Camper Address: _______________________________________________________________ City, State AND Zip: _____________________________________________________________ Camper Church Name AND City: ___________________________________________________ Primary Phone: _________________________ Secondary Phone: ______________________ Camper Cell Phone: ______________________ Camper Email: _________________________ Camper Date of Birth: ____________________ Grade Completed 2015: _________________

Camper Parent(s)/Guardian(s) Name(s): ____________________________________________ Camper EMERGENCY Contacts (please be sure to list at least two different people and their contact information other than Camper parent/guardian). Emergency Contact 1: ____________________________________________________________ Relationship to Camper: ________________________Contact Phone Number(s): _________________

Emergency Contact 2: ____________________________________________________________ Relationship to Camper: ________________________Contact Phone Number(s): _________________

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GRR Camper Registration Form: Page 2/4 Please describe current medical condition(s): ________________________________________ ______________________________________________________________________________ Please list any medications to be taken during Camp along with dispensing instructions (quantity/time of day). ______________________________________________________________________________ ______________________________________________________________________________ The following medications/items may be dispensed by Camp Staff as needed: _____ Acetaminophen _____ Ibuprofen _____ Sunblock _____ Pepto Bismol _____ Skin Creams _____ Personal Care/Hygiene Products Please list any disease exposure, including Chicken Pox, Mumps, Measles, etc.: _____________ ______________________________________________________________________________ Please list any special dietary needs: _______________________________________________ ______________________________________________________________________________ Please list allergies, including food allergies: _________________________________________ ______________________________________________________________________________ Please list any restricted activities: ________________________________________________ Please list level of swim ability: ____________________________________________________ I am current on all vaccinations ____________Date of last tetanus shot ___________________

* * * VERY IMPORTANT INFORMATION * * * Physician’s Name: ____________________ Physician’s Phone: _____________________ Medical Insurance Carrier: ____________________________________________________ Group Number: _____________________ Policy Number: ________________________ Claim Approval Hotline: ______________________________________________________


GRR Camper Registration Form: Page 3/4 Please note: Original Parent/Guardian signatures are REQUIRED PRIOR to start of Camp

Parent/Guardian PERMISSION TO ORDER MEDICAL PROCEDURES (Section I) REQUIRED I, ______________________________________________ give the adult leader(s) for this Event permission to (Parent/Guardian Name)

order any necessary medical procedures for _______________________________________ . (Camper’s Name)

I understand that Event insurance (paid by GRR) is secondary coverage only. Primary responsibility for medical treatment belongs to me and to my health insurance provider. I agree not to hold liable for any uninsured medical expenses the Great River Region, its employees and agents.

� Parent(s)/Guardian(s) Signature: _____________________________ Date: __________________

Parent/Guardian PERMISSION FOR YOUTH TO PARTICIPATE (Section II) REQUIRED I, ______________________________________________do hereby give permission for my child (Parent/Guardian Name) (named above) to participate in the above referenced Event, including other locations connected with the Event and transportation to/from those locations. I furthermore agree to immediately pick up my child from the Event should my child be found to possess alcohol, controlled substances or tobacco; verbally, physically or sexually assault another; engage in illegal activity; or blatantly disregard other Event guidelines or instructions from Event leaders. I am in full agreement with the intent of this Event, i.e., to assist my child in developing a deeper relationship with Jesus Christ and growing into the person God has called my child to become.

� Parent(s)/Guardian(s) Signature: _____________________________ Date: __________________ Parent/Guardian MEDIA RELEASE (Section III) Typically, during GRR Youth Experiences, staff & participants capture the Event on film or video. GRR asks your permission to publish such photographs and videos in connection with GRR Youth Experiences promotional materials.

______ YES, I DO give permission for the GRR to publish photographs and videos of my child in connection with GRR Youth Experiences promotional materials. ______ NO, I DO NOT give permission for the GRR to publish photographs and videos of my child in connection with GRR Youth Experiences promotional materials. � Parent(s)/Guardian(s) Signature: _____________________________ Date: __________________

Youth (Camper) COVENANT OF CONDUCT (Section IV) As a Youth participant (Camper), I agree to follow all rules and instructions set forward by the adult leadership of this Event. I agree to follow all instructions and safety guidelines given to me by the Event staff. I agree to have a good attitude throughout this Event and to behave in a manner consistent with my Christian faith. I understand that if I break Event rules, I can be sent home at my family’s expense.

� Youth/Camper Signature: _____________________________ Date: __________________

� Church Pastor Signature: _____________________________ Date: __________________ Thank you to your Pastor for signing your Camper Registration Form as it assures clear

communication between your Church congregation and GRR.


GRR Camper Registration Form: Page 4/4 In an effort to aid our Camp Staff in caring for your Camper during our overnight, away-from home Camps, we ask that you thoroughly complete the following Camper Profile. For our returning Campers the following Camper Profile is optional.

Camper's Name

Please Select One Camper Experience

First Time at GRR Summer Camp

Returning Camper � Please share your Camper’s expectations for Camp.

� Please describe your Camper’s personality:

� Please share your Camper’s likes & dislikes:

� Please share your Camper’s interests and talents:

� Please share how your Camper is best consoled when upset:

� Please review the list below and indicate any areas which cause you concern for your Camper. Please elaborate on such concern; use additional paper as needed.

Short Attention Span Demanding/Aggressive Behavior Personal Hygiene Hyperactivity Physical Restrictions Sleeping Habits/Concerns Other _______________________________________________________________________ ___________________________________________________________________________________

IMPORTANT REMINDERS: PARENTS: Before you return your Camper Registration Form, please be sure you have completed all 4 pages

including signatures and dates on Camper Registration Page 3 and Camper T-Shirt Size on Page 1. PASTORS: Please be sure to sign Registration Page 3 and triple-check all pages are completed.

COMPLETED, ORIGINAL Registration Forms with full registration fees are due into the Great River Region Office (9302 Geyer Springs Road, Little Rock, AR 72209) by Friday, May 15.


GRR Counselor In Training Program “Learn to lead, by learning to serve.”

Counselor In Training (CIT) Overview The Counselor-In-Training program is a Youth Leadership Opportunity where CITs will be mentored by the GRR Youth Coordinator along with being assigned a Camp Staff Mentor. CITs will attend Discovery and JYF Camp (June 13 through June 17) in their Leadership capacity. We will not have any CITs attend Chi Rho Camp. CITs will learn about leadership in a Camp setting along with attending trainings to lead cabin devotions, energizers, group activities and participate in Camp programming. CITs will be provided a journal along with a CIT Notebook containing leadership and training materials. Eligibility Requirements

� At least 16 years old ON OR BEFORE June 12 � An active Church Member � Previously attended GRR Church Camp � Complete the Camper Registration Form and attend CYF Conference 2015 � Complete and clear background screening (application included in this Information Packet) � Complete CIT Application and submit directly to GRR office no later than Friday, May 15

Please note if you are selected to become a Counselor-In-Training you will have a $100 Camp Fee due in the Regional Office by June 10. These funds will be applied towards the cost of your Discovery and JYF Camp Fees and CIT supplies you will be provided at Camp. Application Requirements All CIT applicants must submit the following documents directly to the GRR office no later than May 15:

� Counselor In Training Application � Background Screening and Consent Form � Letter of Recommendation from Church Pastor � Letter of Recommendation from a Church congregation member � Complete Essay Questions

Application Submission Instructions Mail all completed documents noted above in the Application Requirements section directly to the GRR Office by Friday, May 15. The $100 payment will be required after CIT selections are completed and due into the GRR Office by June 10.

Great River Region

ATTN: Counselor-In-Training Selection Team 9302 Geyer Springs Rd Little Rock, AR 72209


GRR Counselor In Training Application

Please print clearly and thoroughly complete all of the following information. Applicant First Name: ______________ Applicant Last Name: ___________________ Applicant Address: __________________________________________________ City, State AND Zip: __________________________________________________ Applicant Church Name AND City: ______________________________________ Primary Phone: ___________________ Secondary Phone: ________________ Applicant Cell Phone: ______________ Applicant Email: __________________ Applicant Date of Birth: ____________ Grade Completed 2015: ___________

Applicant Parent(s)/Guardian(s) Name(s): ________________________________ CIT Essay Questions Please use up to two sheets of paper (front side only) to provide specific answers in response to the questions below. Be sure to provide details and examples to tell your story.

1. What do you feel is the most valuable youth experience you've participated in at a Great River Region event? List the reasons why this experience was valuable to you.

2. What gifts do you possess that will distinguish you as a leader? Be as specific and thorough as you can. Mention all leadership positions you hold in your church, youth group, school, band, sports, etc.

3. What do you want to experience at CYF Conference this summer? 4. If selected as a Counselor-In-Training (CIT) what do you want to gain from the

experience?

Additional Application Requirements Please remember to attach the following documents to your Application before submitting to the GRR Office:

� Background Screening and Consent Form � Letter of Recommendation from Church Pastor � Letter of Recommendation from Church congregation member � Complete Essay Questions (up to two separate sheets of paper)


GRR Summer Intern Program Youth Adult Leadership – Summer Intern Overview We will have two Interns attending all four Camps (Discovery, JYF, Chi Rho and CYF) this summer along with working in the Great River Region Office. Interns will be mentored by the GRR Youth Coordinator and will participate in leadership trainings. Interns will be responsible for assisting with Camp preparations, leading Camp activities, planning and leading cabin devotions and post-camp deliverables. Eligibility Requirements

� High school graduate 2014 or earlier � Commitment to serve entire Internship (June 8 through July 3) � An active Disciples of Christ Church Member � Must be committed to great leadership on many levels of youth ministry including local, regional and

general Church � Must be committed to a Christian lifestyle � Clear background screening (application included in this Information Packet)

Application Requirements All Intern applicants must submit the following documents directly to the GRR office no later than May 15:

� Intern Application � Background Screening and Consent and Information Form � Resume

• Resume should incorporate Church activities, education, extracurricular activities along with employment history if applicable

� Letter of Recommendation from Church Pastor � Letter of Recommendation from Peer � Letter of Recommendation from Employer

• If no employment history, applicant may substitute a Letter of Recommendation from a Church congregation member

� Essay Questions

Essay Questions Please use up to three sheets of paper (front side only) to provide specific answers in response to the questions below. Be sure to provide details and examples to tell your story.

1. Describe your faith journey including your spiritual gifts 2. Describe your leadership style and leadership experience 3. How have you been investing your time with family, friends, in church, school/work and within your

community? What is this important to you? 4. If selected as an Intern what do you want to gain from the experience and how will you contribute?

Application Submission Instructions Mail all completed documents noted above in the Application Requirements section directly to the GRR Office by Friday, May 15.

Great River Region ATTN: Summer Intern Selection Team

9302 Geyer Springs Rd Little Rock, AR 72209


GRR Summer Intern Application

Please print clearly and thoroughly complete all of the following information. Applicant First Name: ______________ Applicant Last Name: ______________ Applicant Address: __________________________________________________ City, State AND Zip: __________________________________________________ Applicant Permanent Address (if different from above): _____________________ City, State AND Zip: __________________________________________________ Applicant Church Name: ______________________________________________ Applicant Church City: ________________________________________________ Primary Phone: ___________________ Secondary Phone: ________________ Applicant Cell Phone: ______________ Applicant Email: __________________ Applicant Date of Birth: ____________ Education: _________________________________________________________ ___________________________________________________________________ Please note if selected as an Intern you will receive follow up employment papers to complete

prior to the start of your internship. Additional Application Requirements Please remember to attach the following documents to your Application before submitting to the GRR Office:

� Background Screening and Consent and Information Form � Resume

• Resume should incorporate Church activities, education, extracurricular activities along with employment history if applicable

� Letter of Recommendation from Church Pastor � Letter of Recommendation from Peer � Letter of Recommendation from Employer

• If no employment history, applicant may substitute a Letter of Recommendation from a Church congregation member

� Essay Questions


GRR CIT/Counselor Registration Form: 1/2 Counselor Application Requirements All Counselor-In-Training (CIT) and Counselor Applicants are required to complete the CIT/Counselor Registration Form (Page 1 and Page 2) along with the Background Screening Consent and Information Form (Page 1 and Page 2).

Please Check One

Applicant Type T-Shirt Size (YS, YM, YL, S, M, L, XL, 2X; 3X)

Female Counselor In Training

Male Counselor In Training Female Adult Counselor

Male Adult Counselor

Counselor Camp Preference Counselors-In-Training (CIT) will attend Discovery and JYF Camp and will not need to complete the Camp Preference information below. Adults applying to become Camp Counselors should denote for which Camp they would like to be Considered as Counselor. If interested in multiple Camps, please rank the Camps below in order of preference.

Camp Preference Camp Camper Ages Camp Dates Discovery Completed K-2nd June 13 - 14 JYF Completed 3rd - 5th June 14 - 17 Chi Rho Completed 6th - 8th June 17 - 21 CYF Completed 9th - 12th June 21 - 26

Please print clearly when completing the following information: Applicant First Name: ____________________ Applicant Last Name: ___________________ Applicant Address: _____________________________________________________________ City, State AND Zip: _____________________________________________________________ Applicant Church Name AND City: _________________________________________________ Primary Phone: _________________________ Secondary Phone: ______________________ Applicant Cell Phone: ____________________ Applicant Email: ________________________ Applicant Date of Birth: ___________________ GR

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GRR CIT/Counselor Registration Form: 2/2 Emergency Contact Information: Emergency Contact 1: _______________________________________________________________________ Relationship to Applicant: _______________________Contact Phone Number(s): ______________________ Emergency Contact 2: _______________________________________________________________________ Relationship to Applicant: _______________________Contact Phone Number(s): ______________________ Current Medical Information: Please describe any current medical condition(s): _________________________________________________ __________________________________________________________________________________________ Please list any disease exposure, including Chicken Pox, Mumps, Measles, etc.: _________________________ __________________________________________________________________________________________ Please list any special dietary needs: ___________________________________________________________ __________________________________________________________________________________________ Please list allergies, including food allergies: _____________________________________________________ __________________________________________________________________________________________ Please list any restricted activities: ____________________________________________________________ I am current on all vaccinations ____________Date of last tetanus shot _______________________________

* * * VERY IMPORTANT INFORMATION * * * Physician’s Name: ____________________ Physician’s Phone: _____________________ Medical Insurance Carrier: ____________________________________________________ Group Number: _____________________ Policy Number: ________________________ Claim Approval Hotline: ______________________________________________________

Application Submission Instructions Mail all completed documents noted above in the Application Requirements section directly to the GRR Office by Friday, May 15. Great River Region

ATTN: Summer Intern Selection Team 9302 Geyer Springs Rd, Little Rock, AR 72209


Background Screening Consent and Information Form Page 1/2 Counselor-In-Training (CIT) Applicants and Counselor Applicants are required to complete all

relevant information below.

Organization: __________________________________________________________________________________ Applicant’s Full Name (Printed): ____________________________________________________________________ Other Names Used: ______________________________________________________________________________ Social Security Number: ___________________________________________ Date of Birth: _____/_____/________ *NOTE: The above information is required for identification purposes only, and is in no manner used as qualifications for employment, internship, or service as a volunteer. Great River Region of the Christian Church abides by all applicable state and federal employment laws. ADDRESSES (for the past 10 Years) Present Address_________________________________________________________________________________ City__________________________County_______________State________Zip________Country_______________ How Long at Present Address?______________________________________________________________________ Former Address_________________________________________________________________________________ City__________________________County_______________State________Zip________Country_______________ How Long at Former Address?______________________________________________________________________ Former Address_________________________________________________________________________________ City__________________________County_______________State________Zip________Country_______________ How Long at Former Address?______________________________________________________________________ Please list all states and counties of residence since turning age 18: ______________________________________________________________________________________________ ______________________________________________________________________________________________ (Please circle any of the following states in which you have lived: CA, CO, DE, LA, MA, SD, VT, WV, WY) MOTOR VEHICLE RECORDS Driver's License Number: ________________________________________ State of License: __________________ PROFESSIONAL LICENSE or CERTIFICATION VERIFICATION Type of License/Certification: ______________________________________________________________________ License/ Certificate Number: _______________________________________________________________________ State: __________________________________ Date of Licensure / Certification: ____________________________ © 2009, Praesidium, Inc. All rights reserved


Background Screening Consent and Information Form Page 2/2 EDUCATION VERIFICATION Adult Applicants should list each college, university, or other institute of higher education that he or she has attended. Name of Institution: _____________________________________________________________________________ Address: ______________________________________________________________________________________ City: ______________________________________________ State: ___________ Phone: ____________________ Years Attended: ___________________ Degree Awarded: __________________ Major: ______________________ Name of Institution: _____________________________________________________________________________ Address: ______________________________________________________________________________________ City: ______________________________________________ State: ___________ Phone: ____________________ Years Attended: ___________________ Degree Awarded: __________________ Major: ______________________ EMPLOYMENT VERIFICATION Current Employer: ______________________________________________ May we contact? __________________ Name of Supervisor or HR Contact: _________________________________________________________________ Address: __________________________________________ City: _______________________ State: __________ Phone: ________________________ Fax: ________________________ Dates of Employment: ________________ Previous Employer: ______________________________________________________________________________ Name of Supervisor or HR Contact: _________________________________________________________________ Address: __________________________________________ City: _______________________ State: __________ Phone: ________________________ Fax: ________________________ Dates of Employment: ________________

I, ______________________________________, hereby authorize Great River Region of the Christian Church and/or its agents to make an independent investigation of my background, references, character, past employment, education, credit history, adult criminal or police records, and motor vehicle records including those maintained by both public and private organizations and all public records for the purpose of confirming the information contained on my Application and/or obtaining other information which may be material to my qualifications for service now and, if applicable, during the tenure of my employment or service with Great River Region of the Christian Church.

I release Great River Region of the Christian Church and its agents and any person or entity, which provides information pursuant to this authorization, from any and all liabilities, claims or law suits in regards to the information obtained from any and all of the above referenced sources used. The name above is my true and complete legal name and all information provided above is true and correct to the best of my knowledge:

______________________________________________________________________________________________ Signature of Applicant Date Are you applying for employment in California, Minnesota or Oklahoma? Yes___ No___ If so, do you want a copy of any Consumer Report prepared concerning you? Yes___ No___ I understand that California law requires Great River Region of the Christian Church to give me a copy of any report requested within seven (7) days of the date the information was obtained and that failure to do so will expose Great River Region of the Christian Church to liability (Section 1786.29). © 2009, Praesidium, Inc. All rights reserved


Great River Region of the Christian Church 9302 Geyer Springs Road Little Rock, AR 72209

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