2022 Camp Crux Adult Staff

I'm committing to be a counselor for: REQUIRED CAMP CRUX (middle school girls: June 27-30, 2022); Staff arrive on the evening of June 24 CAMP CRUX (middle school boys: July 11-14, 2022); Staff arrive on the evening of July 8 Please fill out this field.

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Address REQUIRED Please fill out this field. Please enter valid data.

City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.

Email REQUIRED Please fill out this field. Please enter an email address.

Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Parent/Guardian First Name REQUIRED Please fill out this field. Please enter valid data.

Parent/Guardian Last Name REQUIRED Please fill out this field. Please enter valid data.

Parent/Guardian Email REQUIRED Please fill out this field. Please enter an email address.

Parent/Guardian Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Birthday REQUIRED

MM/DD/YYYY

Please fill out this field. Please enter a date.

High School Name Please enter valid data.

College Year 2022-2023 (if applicable) Freshman Sophomore Junior Senior Other

College Name (if applicable) Please enter valid data.

In case of an emergency, please contact REQUIRED Please fill out this field. Please enter valid data.

Emergency Contact Phone REQUIRED Please fill out this field. Please enter valid data.

Parish Name & City Please enter valid data.

Do you play a musical instrument? Yes No

If so, what instrument? Please enter valid data.

Would you be willing to share your musical talent at CAMP CRUX either for Mass or around the campfire? Yes No

Do you have any food allergies? Yes No

If yes, please specify any food allergies:

Are there any special concerns for our awareness? Yes No

If yes, please specify:

As a team member of the CAMP CRUX Servant Leader Staff, I am committed to safeguard the young people and the most important gifts God has entrusted to us. The following reflects our commitment and applies to all who serve the young people at CAMP CRUX.

I will:

Safeguard children and youth entrusted to my care at all times.
Treat everyone with respect, patience, integrity, courtesy, dignity, and consideration.
Complete Safe and Sacred children protection training

I will not:

Communicate any views contrary to the teachings of the Catholic Church.
Use, possess, or be under the influence of alcohol while overseeing youth at CAMP CRUX.
Use, possess, or be under the influence of illiegal drugs
Allow minors to have and/or use alcohol or illegal drugs
Use profanity or engage in behavior that is harassing or degrading to others.

I understand and agree to the expectations above REQUIRED Yes No Please fill out this field.