Name *

First Name

Last Name

Birth date *

MM

DD

YYYY

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Emergency Contact Name

First Name

Last Name

Pastors Name

First Name

Last Name

Volunteer position

Kitchen

Camp Nurse (RN)

Projects

Check the date(s) you will be able to serve:

Staff Training: June 9-14

Teen 1: June 16-21

Jr High 1: June 23-28

Young Adventures 1: June 30-July 4

Young Adventures 2: July 7-11

Teen 2: July 14-19

Jr High 2: July 21-26

Young Adventures 3: July 28-Aug 1

Young Adventures 4: Aug 4-8

Phone

(###)

###

####

Phone

(###)

###

####

Agreements *

Please check the agreements and sign below. You can access Pioneer Bible Camp's Statement of Faith here.

The information in this application is correct to the best of my knowledge.

I authorize all references to disclose any information that they may have regarding my character and fitness for serving at PBC.

I consent to a background check

I agree with PBC's statement of faith and agree to submit to PBC's dress policy.

Date Signed

MM

DD

YYYY