2024 Summer Camp Adult Leader Form

First Name *

Middle Name

Last Name *

Male or Female *

Cell Number *

My Email Address *

Street Address *

City *

State *

Zip Code *

Emergency Contact First Name *

Last Name *

Phone Number *

Please select which camp(s) you would be willing to participate in: *

6th - 12th Grade Camp June 21-23 Only

2nd-6th Grade Camp June 23-25 Only

Both 6th-12th Grade Camp & 2nd-6th Grade Camps June 21-25

Either one but not both Camps

Background Check Authorization

To better serve and protect the safety and security of all involved persons serving at this and future events involving Rocky Mountain Region Church of God (RMRCOG) and to meet the standard requirements for events involving minors. I hereby authorize the designee for RMRCOG to perform a background check and receive any information pertaining to me. I fully understand that any information obtained therein will be used in the determination of volunteering in the various camps and ministries organized by RMRCOG. This background check could include, but is not limited to, performing national and statewide criminal history record search, the national sex offender registry, social security trace, and motor vehicle report. I consent to the RMRCOG designee to perform the aforementioned checks as needed for the duration of my volunteer service.

Upon completion of the background check, you will receive a short video discussing child safety. Please take a moment to watch the video. Thank you!

SSN # *

Date of Birth *

Driver's License # *

State of issue: *

Please list the name, phone number, and email address of a church leader for personal reference.

First Name *

Last Name *

Church Leader Email *

Church Leader Cell Number *

Church Name *

Church Phone Number *

All registrants must complete the following:
I recognize that I am responsible for my behavior. I am dedicating myself to the lofty goal of preparing myself for an intense, life-changing, encounter with God. I will conduct myself in a respectful, mature, and courteous manner. I will adhere to all rules and policies and I will honor those who are over me in the Lord. I will do everything in my power to ensure that this event is a spiritual success for myself and those I am leading.
Signature: *

clear

Date: *