Intern Application

Name *

First Name

Last Name

Phone *

(###)

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Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Gender

Female

Male

Marital Status *

Single (as a Pringle)

Single (but exploring my options)

Engaged

Married

Name *

First Name

Last Name

Phone *

(###)

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Name *

First Name

Last Name

Phone *

(###)

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Name of Primary Care Physician

First Name

Last Name

Primary Care Physician Phone Number

(###)

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Medical Release *

In case of medical emergency, I understand that Shiloh Bible Camp personnel need the completed Emergency Authorization Form to authorize treatment. By checking the box below, I am agreeing to fill out this form and sign it.

Yes, I agree.

No, I do not agree.

Are you a believer in Jesus Christ, that he died and rose again in order to save us from our sin, and that He is coming again someday? *

Yes

No

Will you bring your own car? *

Yes

No

I don't know

Pastor's Name *

First Name

Last Name

Church Phone Number *

(###)

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Supervisor's Name *

First Name

Last Name

Phone

(###)

###

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Can we call them for a reference?

Yes

No

Reference 1 *

First Name

Last Name

Phone *

(###)

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Reference 2 *

First Name

Last Name

Phone *

(###)

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Reference 3 *

First Name

Last Name

Phone *

(###)

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Sexual Conduct Policy *

It is the policy of Shiloh Bible Camp to forbid any form of sexual activity, whether physical or verbal between campers, staff and campers, or unmarried staff. Sexual activity is described as any activity, whether physical or verbal, which is intended to produce or derive sexual stimulation or pleasure. Any such activity by staff could result in immediate dismissal, and in the event of staff/camper involvement, could also result in criminal charges being filed. If the applicant is under 18 their parent/guardian must sign for them.

I understand and agree to follow the Sexual Conduct Policy

T-Shirt Size *

Small

Medium

Large

X-Large

2X-Large

3X-Large

4X-Large