Personal Information
Applicant's Name *
Applicant's Name
Birthdate *
Birthdate
Gender *
Mailing Address *
Mailing Address
Home Phone *
Home Phone
Cell Phone *
Cell Phone
unisex: small - XXL
Church Background and Activity
Personal Questions
Please answer these questions honestly.
Health Information
Applicant's Name *
Applicant's Name
Doctor's Phone *
Doctor's Phone
Next of Kin *
Next of Kin
Next of Kin Address *
Next of Kin Address
Next of Kin Home Phone *
Next of Kin Home Phone
Next of Kin Cell Phone
Next of Kin Cell Phone
Next of Kin Work Phone
Next of Kin Work Phone
Emergency Contact *
Emergency Contact
This should be someone different than the person named next of kin.
Emergency Contact Home Phone *
Emergency Contact Home Phone
Emergency Contact Cell Phone
Emergency Contact Cell Phone
Emergency Contact Work Phone
Emergency Contact Work Phone
Health History
Do you suffer from any medical/emotional condition that in any way restricts normal activities including land and water sports? *
Are you subject to any of the following? *
Have you been treated by a health care professional for any medical/emotional conditions in the past 12 months? *
Please list any allergies that you have. *
If you are not taking any medication, please write 'none'.
Are you on a special diet? *
I declare this health history to be accurate to my knowledge. I hereby give permission to the doctor/nurse selected by the camp to provide me with medical treatment in the case of an emergeny.
Signature *
Signature
Parent/guardian if applicant is under 18 years of age.
Date *
Date
References
All Applicants need to provide the names of 1 Pastor/Mentor and 1 Adult Acquaintance over 25 years of age who has known you for at least 3 years and are not relatives. Redberry Bible Camp will send detailed reference forms directly to your references using the email that you provide for them. Please inform your references that they will be receiving a form from Redberry Bible Camp to fill out regarding your application.
Reference #1 Name *
Reference #1 Name
Phone *
Phone
Reference #2 *
Reference #2
Phone *
Phone
Authorization of the Applicant regarding Reference Forms *
Authorization of the Applicant regarding Reference Forms
I authorize the release of the disclosed information by the person completing this character reference form for the consideration of the applicant. I waive any right or privilege to inspect or challenge the contents of this form. I understand that the information will be held in confidence by RBC and will not be released to anyone (other than employees, agents, representatives, and/or professional advisors of RBC) without the permission of the person giving such character reference of in the absence of Court Order, Subpoena or laws requiring the disclosure of such information.
Date *
Date
Choose a Session
This year's Foundation Program is 3 weeks long. There will be 2 sessions ran during summer. Please choose one of the following sessions. *
Choose a Program
Criminal Record Check
All applicants are required to hand in a Criminal Record Check and Vulnerable Sector Check to be able to work at Redberry Bible Camp. These checks can be obtained from your nearest police station. If you are accepted into this program, we will provide a letter that you must present to the police station when you go to get the checks done.
Signatures
In submitting this application I declare that all of the information is accurate to the best of my knowledge.
Signature of Applicant *
Signature of Applicant
Signature of Parent or Legal Guardian if applicant is under the age of 18 years old.
I here by give permission for the above applicant to participate in the Foundation Program that they have chosen at Redberry Bible Camp.
Signature of Parent/Guardian
Signature of Parent/Guardian
Date *
Date
Program Costs
The cost of the program is $300 for the entire 3 weeks. Please indicate how you will be paying.
Payment Options *