The camp for which you are applying: (If you would like to be considered for more than one camp, please indicate)

Special talents which you have experience and the ability to lead:

Describe your previous leadership at camp and/or other youth programs.

How do you plan to contribute to the faith journey of those involved in this Christian camp?

Do you give permission for CCNC-N to use photos of your likeness for camp promotional materials?

The following information is required to ensure that your individual needs are met while attending camp. Information is confidential and will be made available only to those people who are directly responsible for your well being. In the event of an emergency, every effort will be made to contact the emergency contact.

Have you been subject to any of the following in the past year? Please check all that apply.

Have you been subject to any of the following more than a year ago? Please check all that apply.

Is there additional information which would be of help in promoting your welfare while at camp?

Are there activities that you should not participate in while at camp?  If so, please explain

If the camper requires medical treatment while at camp, your family's or camper's health insurance information will be used at the hospital.  Please provide that information below.

If the treatment listed below is acceptable for the corresponding symptoms, do not bring the listed medication unless you take them on a regular basis. These non-prescription drugs will be provided.  (Generic brands may be substituted for name brands listed here.)

Check all symptoms/medications you do not wish to be treated.

Medications: Please list amount and times for each medication that you take on a regular and as needed basis. (Inhalers, adrenaline-EpiPens) This information can be updated at any time or when you arrive at camp. All medications must be in their original packaging and will be administered by the health supervisor during camp.  All medicines, including vitamins, must be turned over to the camp health care supervisor.

Please list the name of the medication, dosage, and frequency:

2025 COVID Procedures
• It is the strong preference of the Outdoor Ministry Committee and the Christian Church (DOC) of Northern California/Nevada Region, that, if possible and available to them, the site staff and volunteer staff should be vaccinated prior to camp. The camp nurse should also be vaccinated prior to camp.
• Masks are purely optional.
• If a camper or counselor shows symptoms of COVID during camp, that individual will be isolated from their small group, with proper supervision, and a COVID test will be taken. If positive, the staff person will continue to be isolated.

Social Media Usage Guidelines for All Regional Youth Ministries - Christian Church of Northern California-Nevada (CCNC-N)
(Cyber Policy)

CCNC-N views social networking sites (e.g. Facebook, Twitter, Snap Chat, etc.), personal websites, and weblogs, as an appropriate manor of self-expression during non-camp time. During the week of summer camp however, we would ask that staff refrain from unnecessary and avoidable electronic posting and/or communication, and that all youth participants refrain from any kind of electronic posting and/or communication.
If after summer camp, staff persons or campers choose to identify themselves as participants in one of our camp programs on such Internet venues, they may be viewed by a third party as a representative of CCNC-N. In light of that possibility, our program will ask all camp participants to be in the following covenant, and that all observe the following guidelines when referencing the camp, its programs, activities, other campers, volunteers, camp staff, or regional church leaders, in any electronic posting and/or communication.

- I will always be respectful of those that are mentioned and/or may read any of my electronic postings and/or communications.
- I will not use obscenities, profanity, or vulgar language.
- I understand that it is unacceptable to harass, bully, or intimidate anyone via electronic communication. (Behaviors that constitute harassment, bullying, or intimidation include, but are not limited to: derogatory comments with respect to race, religion, gender, sexual orientation, economic status, culture, or disability; and comments that are sexually suggestive, humiliating, or demeaning; and comments that threaten to stalk, haze, or physically injure another camp participant)
- I will not use electronic communications to discuss engaging in conduct that is prohibited by any camp policies or covenants.
-  As a staff person I will not initiate any electronic communication through social media websites with campers, nor will I post any photos or video of any campers.

Policy for Off-Season Counselor/Camper Contact
 for the Camping Program of
 The Christian of Northern California-Nevada

Camp staff persons are chosen for their mature faith and ability to share their faith with youth.  It is expected and hoped that deep relationships will develop as a result of that sharing.

Many appropriate friendships between counselors and individual campers continue in some form after camp; however, there are counselors who use children to get more of their emotional needs met than is healthy.  When this is the case, difficult problems can arise.  These problems can include children suffering hurt feelings when not included, not receiving adequate supervision, or developing an over stimulating attachment with the counselor, which may become a setup for potential abuse.  Furthermore, some off-duty counselors find themselves in relationships with children who are more , needy or demanding than they can handle.  Without the checks and balances that a camp's staff structure and supervision provide, they may end up doing something they did not consciously set out to do.

The Outdoor Ministries Committee encourages healthy Christian relationships between campers and counselors.  In concern for the safety of both campers and counselors, the committee has adopted the following guidelines in regard to off-season contact between camp staff and campers:

1. Camp staff may not initiate or solicit a relationship with a camper through written, verbal, physical, or internet communication.
2. There is to be no one-on-one contact between camp staff and campers.  Any off-season outing should be done in groups with parental knowledge.
3. If the camper initiates/solicits a relationship with a staff through written, verbal, or internet communication, the following guidelines are recommended for the safety of both:

• An adult staff member should never discuss with a camper details of personal problems/issues with which the staff member is dealing;
• If a camper brings up his or her own personal problems/issues, the staff member should let the camper know that they are listening but should refrain from offering too much advice.  Instead, the staff member should encourage the camper to talk to someone in their own family or church (e.g., their parent or pastor);

 Staff members should keep copies of any correspondence they direct to a camper and to ask another staff member or other mature adult (e.g., the regional staff person or camp director) to view a copy.

Remember that adult camp staff members have a huge impact on young lives, and it is our responsibility to protect those young lives from harm.

If you have been issued a Regional Directive code, please enter it here, otherwise, leave it as is.