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MISSION CAMPTEAM MEMBER APPLICATION FORM

For Camp:______________________________

PERSONAL DETAILS:Name: DOB: M /

FAddress: Post Code:Phone: Mobile:Email:

EMERGENCY CONTACTS:Contact Person #1: Relationship

:Phone:

Mobile:

Contact Person #2: Relationship:

Phone:

Mobile:

MEDICAL DETAILS:Medicare #: Health Insurance

Details:Doctors Name: Phone

#:

Provide details of any medical or other condition(s) that Lutanda should be aware of to ensure the health and safety of yourself and/or others whilst at camp:

DIETARY REQUIREMENTS: None Vegetarian Diabetic Gluten Free Lactose

Intolerant Food Allergy:

________________________ Other: ________________________

Lutanda: Life changing experiences

OTHER DETAILS:Have you attended Lutanda camps previously? Y / N

If yes, please state the site, year(s) and in what capacity (eg. Leader / Camper):

Are you a committed Christian? Y / N

Please briefly outline how you became a Christian:

What Church are you currently attending?:

Explain why you would like to be involved in this Camp:

Explain the personal talents/experience you have which may be helpful during camp:

Do you have a current first aid certificate? Y / N

As an exciting part of the camp experience video footage and photos are taken of youexperiencing the fun of camp:

I agree to allow footage and/or photos of myself to be used solely for promotional purposes.

REFEREES

Please provide at least 2 referees from your fellowship (eg. Pastor, Ministry Leader): Referee 1 Name: Position:

Phone:

Referee 2 Name: Position:

Phone:


STATEMENT OF BELIEFS

We believe:1. That the Bible, consisting of the Old and New Testament, is the Word of God and that as such it is

without fault or error and is of final authority in all matters of faith and daily living.2. There is only one God who exists in three persons - the Father, the Son and the Holy Spirit. God is the

creator, sustainer and rightful ruler of all things.3. As the result of Adam’s sin, all mankind was separated from God and fell into sin. We are unable to

save ourselves or remove the barrier between God and us, created by our sin.4. God came in the person of the Son of God, became a man (Jesus), suffered and died on a cross to

bear the just penalty for our sins in order to restore us to fellowship with God. He physically rose from the dead on the third day and went up into heaven where he was enthroned as Lord of all.

5. He poured out his Holy Spirit, who comforts, guides and empowers his people for service.6. Only through hearing the Good News about Jesus can people be saved as they repent of their sins,

put their trust in Christ and change the direction of their lives to serve him as their Lord with the help of God’s Holy Spirit.

7. On the last day, Jesus will return to judge all people. All people will be physically raised from the dead. Those who are in Christ will live forever in a new creation. His enemies will be cast into hell forever.

8. God has commanded us therefore, to spread the Good News about Jesus and call everyone to change his or her attitude and believe in Him.

PERSONAL ACCIDENT COVER AT LUTANDA

You are covered under a Voluntary Workers insurance policy whilst at camp. This cover is in the event of death or permanent disability only. There is no private medical cover under this insurance.

PERSONAL DECLARATION:

I wish to attend the camp for the period indicated, and accept the camp conditions, fees and standards.

Whilst at Lutanda I agree to follow the direction and regulations of Lutanda. I accept the conditions of the Personal Accident Cover stated above. I understand that whilst everything practical is done to care for participants by the camp organisers

and leaders, Lutanda Children's Services will not incur any responsibility whatsoever for any accident or sickness, or any damage to property which may happen through any circumstance.

I understand that I will be financially responsible for any damages incurred whilst at camp. Should the camp administration consider at any time that I require hospital or medical treatment, I

hereby consent to Lutanda Children’s Services obtaining this immediately and at my expense, including ambulance fees.

I have read the ‘Statement of Beliefs’ below and agree to communicate only these beliefs whilst at camp.

I have read and signed the “Prohibited Employment Declaration” attached to this form. I agree to complete the process required for a ‘Working With Children Check’ I authorise the referees listed in this application to release any information they may have regarding

my character and fitness for leadership at Lutanda. The information in this Application is correct to the best of my knowledge.

Applicants Signature: DATE:

Parent/Guardian Signature:

DATE:

(required if leader is under 18yrs)


Thank You for your willingness to serve in this way!

APPLICATION PROCESSOnce received, your application will be checked with the Camp Director for suitability. If accepted, you will receive information about meetings times and dates; where other information of the camp will be given. If for some reason your application as a Team Member is not accepted, an explanation will be given. All successful applicants will be expected to attend all camp meetings and training dates.

I wish to pay my $______ leader’s fees by (please tick):

Credit card Cheque/money order(complete details below) (payable to Lutanda Children’s Services)

Visa MasterCard

Card number: __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __

Expiry Date: __ __ / __ __

Name on Card: _______________________________________

Signature of Cardholder: ______________________________________________

Please bring this completed application form to the next camp meeting.


Direct Deposit (please credit to Account below)

Bank: WestpacBranch: Pennant HillsA/C Name: Lutanda Children's ServicesBSB: 032 087A/C No: 590 037Payment Reference: Leader Surname/Initials

6.4 PROHIBITED EMPLOYMENT DECLARATION

The Commission for Children and Young People Act 1998 makes it an offence for a prohibited person (a person convicted of a serious sex offence, the murder of a child or a child-related personal violence offence, as well as a Registrable person under the Child Protection (Offenders Registration) Act 2000) to apply for or otherwise attempt to obtain, undertake or remain in, child-related employment. It does not apply if an order from the Industrial Relations Commission, Administrative Decisions Tribunal or Commission for Children and Young People, declares that the Act does not apply to a person in respect of a specific offence.

For further information on what is child-related employment see the Working With Children Employer Guidelines.

Section 33B of the Commission for Children and Young People Act 1998 defines a serious sexoffence as:

an offence, involving sexual activity or acts of indecency, committed in New South Wales and that was punishable by penal servitude or imprisonment for 12 months or more; or

an offence, involving sexual activity or acts of indecency, committed elsewhere and that would have been an offence punishable by penal servitude or imprisonment for 12 months or more, if it had been committed in New South Wales; or

an offence under section 80D or 80E (sexual servitude) of the Crimes Act 1900, committed against a child; or

an offence under Sections 91D-91G (child prostitution, other than if committed by a child prostitute) of the Crimes Act 1900 or a similar offence under a law other than a law of New South Wales; or

an offence under Section 91H, 578B or 578C (2A) (child pornography) of the Crimes Act 1900 or a similar offence under a law other than a law of New South Wales; or

an offence of attempting, or of conspiracy or incitement, to commit an offence referred to in the preceding paragraphs; or

any other offence, whether under the law of New South Wales or elsewhere, prescribed by the regulations.

NOTE: A conviction for carnal knowledge is classified as a serious sex offence under this legislation.Section 33B of the Commission for Children and Young People Act 1998 defines a child-related personal violence offence as an offence committed by an adult:

involving intentionally wounding or causing grievous bodily harm to a child; or of attempting, or of conspiracy or incitement, to commit such an offence.

Under Commission for Children and Young People Act 1998: it is an offence for a prohibited person to apply for or otherwise attempt to obtain, undertake or

remain in child related employment; employers must ask existing employees, both paid and unpaid, and preferred applicants for child-

related employment to declare if they are a prohibited person or not; all people in child-related employment must inform their employers if they are a prohibited

person or remove themselves from child-related employment; and penalties are imposed for non compliance.

I am aware that I am ineligible to apply for or otherwise attempt to obtain, undertake or remain in, child-related employment if I have been convicted of a serious sex offence or child-related personal violence offence as defined in the Commission for Children and Young People Act 1998, or if I am a Registrable Person under the Child Protection (Offenders Registration) Act 2000.

I have read and understood the above information in relation to the Commission for Children and Young People Act 1998. I am aware that it is an offence to make a false statement on this form.


I consent to a check of my relevant criminal records, to verify the statements I have made here, being undertaken by the NSW Commission for Children and Young People for monitoring and auditing purposes in accordance with Section 36 (1)(f) of the Commission for Children and Young People Act 1998.

I declare that I am not a person prohibited by the Act from seeking, obtaining, undertaking or remaining in child related employment.

I understand that this information may be referred to the Commission for Children and Young People and/or to NSW Police for law enforcement purposes and for monitoring and auditing compliance with the procedures and standards for the Working With Children Check in accordance with Section 36 (1)(f) of the Commission for Children and Young People Act 1998.

All fields must be completed. Please use block letters.Name:____________________________________________________________________________________

Aliases (previous/other names):________________________________________________________________

Date of birth: _______________________________________________________________________________

Signature:__________________________________________________________________________________

NOTE: Seek legal advice if you are unsure of your status as a prohibited person.


working with children check for camp leaders memb… · web viewi am aware that i am ineligible...

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