Online Counselor Application Manna Resort Counselor Application - 2017 Step 1 of 3 33% Applicant Name* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Applicant Birthday* Applicant Age*Please enter a value between 5 and 80.Sex*MaleFemaleApplicant Phone*Applicant Email* Which camps would you like to help with? Junior High Camp June 29 - July 3 Senior High Camp June 22 - 27 Day Camp July 8 Kid's Camp 1 July 9 - 13 Primary Camp July 7 - 8 Kid's Camp 2 July 16 - 20 Save and Continue Later Parent Name (if you are under 18) First Last Parent PhoneEmergency Contact Name* First Last Emergency Contact Phone*Please list any alergies, medical conditions or limitationsPlease list medication you are takingName of Insurance Company*Policy Number*Doctor's Name* First Last Doctor's PhoneCheck all that apply I am certified in CPR/First Aid. I am a certified lifeguard. Please list all previous youth/child related workWhat's your t-shirt size?*Child M (10-12)Child L (14-16)Adult SmallMediumLargeXLXXLXXXLHow many years have you helped at Manna?This will be my first time!1-2 years3 or moreHave you ever been accused or convicted of any form of child abuse?*YesNoPlease explain*Have you ever been convicted of a crime?*YesNoPlease explain* Medical Consent and Release In the event of a medical emergency, and I cannot be reached during my child’s participation at Manna Resort, I give permission to the doctor selected by Manna Resort to secure treatment, hospitalize, perform surgery, and prescribe medications as deemed necessary to protect my child's health and well-being. I also authorize Manna Resort to administer any medication, whether brought by the camper or available here (such as acetaminophen, ibuprofen, or other non-prescription drugs) as deemed advisable by the camp staff or a doctor, and to administer first aid when necessary. Further, in signing this form, I hereby certify that I give permission for my son or daughter to participate in the camping program of Manna Resort Christian Camp. I release Manna Resort, its agents, employees, or representatives from all claims or actions from the above named minor child participating in camp. My signature also gives permission for my child's picture to be on our website or promotional material.Applicant Signature*Parent Signature (if applicant is under 19)* Save and Continue Later The following is a list of questions that will help us get to know you. If you have filled out the Manna application before then you can skip questions 1 and 2.1. How and when did you become a Christian?*2. How does your faith affect your daily life?*3. How do you keep your relationship with Christ active and growing?*4. What talents, abilities, or experiences do you have that you would be willing to share with us this summer?*If you have any additional information about yourself or concerns and questions you would like to ask please use the space below.*Please list the names, relationship, (pastor, teacher, friend, etc.) and phone number of two references we may call.Name First Last Relationship to applicantPhoneName First Last Relationship to applicantPhonePlease list the name, address, and phone number of the church you most recently attended.Church NameCIty, StatePhoneMay we contact this church to confirm the information?YesNoNameThis field is for validation purposes and should be left unchanged. Save and Continue Later This iframe contains the logic required to handle AJAX powered Gravity Forms.