First Time CCA Application – Northern Pines Family Camp

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Thank you for your interest in serving at Northern Pines as a CCA! After applying, you and your parent or guardian will receive an email confirming the submission of your application. Your parent will receive a note about the week you applied to serve and the people you listed as a reference; if you include your own email, you will receive a full receipt of your application. The application confirmation does not mean you will or won't be a CCA, just that we received your application. We will review applications and followup in March. Please contact us at CCA@npines.org if you have any questions.

Please note, if you leave or refresh this page before successfully submitting the form, your progress will not be saved. To avoid losing your work, you can write the longer answers in a notes or document application and then copy and paste into the form fields.

Your Information

Name(Required)

First Last

Nickname or Preferred Name

For initial communication, our system will use your first name, but it is helpful to know if you go by a nickname.

Gender(Required)

Female

Male

Date of Birth(Required)

Month

Day

Year

Age at camp(Required)

Grade Next Year(Required)

Please select the grade you will be going into after camp (not the grade you are currently in when applying).

7th Grade

8th Grade

9th Grade

10th Grade

11th Grade

12th Grade

First Year after High School

Potential Fees

CCAs do not pay for their week at Northern Pines. However, there are fees if you stay for the transition weekend, if you choose to take the bus to/from Minnesota, or if you request a special diet for the week. You will have an opportunity to confirm these choices later. More details will follow closer to camp.

I might stay on campus for the transition weekend

I might take the bus from Minnesota to Green Lake before week 1

I might take the bus from Green Lake to Minnesota after week 2

I might need a special diet for the week

Service Details

Which week(s) are you applying to serve?(Required)

Please review the upcoming conference details for the specific dates. You will need to arrive on campus by 2 pm on Sunday.

Week 1

Week 2

Both Weeks

My Childcare Experience(Required)

I don't have a lot of babysitting experience

I've participated in a babysitting training course

I have been babysitting for less than a year

I have about one to two years of babysitting experience

I have more than three years of babysitting experience

I have experience with young babies and changing diapers

I have experience with toddlers and toddlers in diapers

I don't have a lot of experience with babies/toddlers, but have experience with older kids

My Childcare Experience—Details(Required)

Please describe your babysitting training and/or experience. (Please remember, if you leave or refresh this page before successfully submitting the form, your progress will not be saved.)

Please describe your faith(Required)

Please let us know how you know you are a Christian, or where you are in your faith journey? (Please remember, if you leave or refresh this page before successfully submitting the form, your progress will not be saved.)

Christian Activities(Required)

Please share some christian or church-based activities in which you are presently active. (Please remember, if you leave or refresh this page before successfully submitting the form, your progress will not be saved.)

Why do you want to serve as a CCA?(Required)

(Please remember, if you leave or refresh this page before successfully submitting the form, your progress will not be saved.)

Do you have any health conditions that would prevent you from carrying out your duties as a CCA?(Required)

Yes

Unsure

Health Concerns(Required)

If you answered "yes" or "unsure", please provide additional details

Do you use tobacco, alcohol, or drugs?(Required)

If yes, you are stating you will abstain during staff training and while serving on staff at Northern Pines.

Yes

Anything else you'd like to add about your application?

If accepted, you will have an opportunity to share more specific requests when filling out your CCA confirmation form. Specific requests shared here will not be saved.

Applicant Statements

Statement of Accuracy(Required)

The information contained in this application is correct to the best of my knowledge. I authorize any references or churches listed in this form to give you any information (including opinions) they may have regarding my character and fitness to work with children. In consideration of the receipt and evaluation of this form by Northern Pines of Minnesota, I hereby release any individual, church, youth organization, charity, employer, reference, or any other person or organization, including record custodians, both collectively and individually, from any and all liability for damages of whatever kind or nature which may at any time result to me, my heirs, or family, on account of compliance or any attempts to comply, with this authorization identified by me in this form. I further state that I HAVE CAREFULLY READ THE FOREGOING RELEASE AND KNOW THE CONTENTS THEREOF AND I SIGN THIS RELEASE AS MY OWN FREE ACT. This is a legally binding agreement which I have read and understand.

I agree

Northern Pines Statement of Faith(Required)

The following Statement of Faith is the foundation of Northern Pines and the Children's Program—where our CCAs serve: I believe in the Bible as the Word of God, a divine revelation, in the original language verbally inspired in its entirety. Acceptance of the Bible as the final authority in all matters. I believe in the Deity of the Triune God: God the Father, Christ the Son, and the Holy Spirit. I believe in the Deity of the Lord Jesus Christ, His substitutionary atonement for sin, His bodily resurrection and His personal, visible return to earth to reign in righteousness and glory. I believe in the person of the Holy Spirit and His Word of conviction, regeneration and sanctification; Who indwells every believer. I believe in the necessity of the New Birth, in Salvation by faith in Jesus Christ alone. I believe that the Church is the Body of Christ, a spiritual organism of born again believers who publicly confess Christ, and remember His death in the sacrament of communion. I believe in the importance of a life wholly committed to the will of God, in Christ.

In signing this statement, I am indicating that I understand the position of Northern Pines on these matters, and as a CCA, I will uphold them in word and action.

Standards of Conduct(Required)

Should I be accepted, I agree to be bound by the Bylaws and policies of Northern Pines of Minnesota, and to refrain from unscriptural conduct in the performance of my services on their behalf. I certify that (a) no civil, criminal, or ecclesiastical complaint related to sexual misconduct ever has been sustained or is pending against me; (b) I have never resigned or been terminated from any paid or unpaid position for reasons related to sexual misconduct. I understand that any false or inaccurate statement made in this application will be grounds for the immediate revocation of all privileges and immediate dismissal from the staff. Note: If you are unable to make the above certification, please contact us at CCA@npines.org to provide a description of the complaint, termination, or the outcome of the situation and any explanatory comments you care to add.

I agree

I'll email CCA@npines.org to set up a time to discuss

References

All applicants—new and returning—are required to provide references. These references cannot be related to you (sibling, parent, aunt, grandparent etc.). References should not have connections to Northern Pines and should be someone who has interacted with you within the last year. Please communicate with your two references before submitting this form. We will email them with a link to the reference form on our website.

Permission to Contact References(Required)

You have my permission to contact my references on my behalf to ask them to fill out a reference form online.

Reference #1

Reference #1 Name(Required)

First Last

Reference #1 Email(Required)

Enter Email Confirm Email

Reference #1 Phone(Required)

How do you know this reference? (r1)(Required)

Reference #2 Name(Required)

First Last

Reference #2 Email(Required)

Enter Email Confirm Email

Reference #2 Phone(Required)

How do you know this reference? (r2)(Required)

Home Church

Church Name

Church Phone

Church Website

Church Location

City State / Province / Region

Applicant's Contact Information

For all minors, our primary email communication will be to your parent or guardian's email address. However, you can include your personal email and phone number if desired.

Mailing Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

My Email

My Phone

Parent or Guardian's Name(Required)

First Name Last Name

Parent or Guardian's Email(Required)

Enter Email Confirm Email

Parent or Guardian's Phone(Required)

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