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Do you have any physical limitations that would hinder your active participation in a strenuous camping program?
Do you use any of the following:
Bancroft Gospel Ministry carries accident insurance on each staff member while they are engaged in camp activities. Do you understand that BGM will assume no further financial responsibility in case of accidents which are unrelated to camp work?

Emergency Contacts

Please give the name, address, and phone numbers of people to be notified in case of illness or emergency
Name and how many years have you completed at the following?

Christian Testimony and Service

Please use the space below to describe your initial encounter with Jesus Christ and your journey as His disciple:
Please describe your past and present activities in Christian ministry working with kids that you are involved with (teaching, youth work, etc.):
To what denomination and local church do you belong?
Experience as a camper (# of years, places):
Experience as camp staff (# of years, places):
Would you be able to be with us all summer?
If not, what are the dates you would NOT be able to be with us?
Are you prepared to serve in whatever capacity may be deemed necessary for the best interest of the camp and under the appointed department heads?
Bancroft has a pool and the counselors are required to supervise the activities during pool times. What is your present swimming classification:
Select a classification:
Why do you want to be a summer counselor?
The following questions are to protect Bancroft from liability should a problem of this kind arise. Should something of this nature happen we would be required to show that these questions were asked prior to hiring someone. If you prefer, you may refuse to answer the questions, or you may discuss your answer in confidence with the senior director rather than answering them on this form. Answering yes, or leaving the question unanswered, will not automatically disqualify an applicant for children or youth work.
  • Have you ever been convicted of or pleaded guilty to a crime?
  • Were you a victim of abuse or molestation as a minor?


Please provide the FULL NAME, COMPLETE ADDRESS, AND PHONE NUMBER of ALL 4 of the following references:
state that the information contained in this
application is correct to the best of my knowledge. I authorize any references or churches listed in this application to give you any information (including opinions) that they may have regarding my character and fitness for children or youth work and any background checks Bancroft needs to obtain. Should my application be accepted, I agree to be bound by the bylaws and policies of Bancroft Gospel Ministry, and to refrain from unscriptural conduct in the performance of my services on behalf of the ministry.
**By typing your name below, you authorize this as your digital signature.

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