Music and Drama Camp Adult Application by Maranatha Please make sure that you have watched the children's worker video and read the abuse prevention policies before starting to fill out this form. You will also need the phone numbers and email addresses of your two references.Name* First Last Your name as you would like it to appear on your nametag.*Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Email* Phone*T-Shirt Size (adult sizes)*SmallMediumLargeX-LargeXX-LargeSelect the Adult Camp Opportunity You Desire:*I am an adult providing supervision from 5:00 pm to 8:00 am. I may also desire to participate in a track of my choice during the day. (Pay: Room/Board)I am an adult desiring to stay in the dorms, but do not want to assist with camp in any way (Cost: $100 for Room/Board)I am an adult working as a camp faculty member (by invite only). (Pay: Meals and Small Honorarium)I am an adult participating in a camp track, but not providing supervision from 5:00 pm to 8:00 am. (No cost to participate. Meal Tickets can be purchased at the Dining Complex)I am a Maranatha college student assisting with a particular track during the day and providing dorm supervision in the evening (Pay: Room/Board and $150 towards travel expenses)I am a college student helping in a track during the day, but not staying in the dorms (meals provided).I am volunteering in the Costume Cottage (Room and Board provided).Select the Camp Track You Prefer:PianoStringsBandMusical/DramaStage CrewVideoOp Staff (Jobs such as Camp Store, Activities, Photos, Videos, Facebook etc.)Which instrument do you intend to play at camp (if applicable)?College Students-Select the Academic Credit Option You Prefer:Music Education: No fieldwork credit available.Piano/String Pedagogy: Fulfills 1 semester of fieldwork (for reporting fieldwork, see pedagogy fieldwork requirements). Piano pedagogy students graduating in less than 8 semesters may substitute a required semester of prep school student teaching with this option (with additional assignments). Obtain permission from Janet Tschida before applying.Any Music Degree Student: Fulfills 1 academic internship credit. No tuition will be assessed for this credit; however, you will need to pay the transcript fee of $25. See music internship course syllabus requirements for additional details. Obtain permission from David Ledgerwood before applying.Drama Productions: Internship in directing, stage work, or costuming (see DP Internship Requirements). Fulfills one required or elective course. Obtain permission from Jeff Miller before applying.No Academic CreditHousing/Rooming Info:Will you be staying in the dorms?*YesNoWill you be staying in the dorm on Sunday night?*YesNoWill you be staying in the dorm on Friday night?*YesNoIf you want specific campers/sponsors in your room, please list their names below:Arrival* I will arrive no later than 7:00 p.m. (counselor orientation) on Sunday, July 16. If I require an arrival time exception, I have already cleared this with Dr. Ledgerwood. Note: Costume Cottage volunteers do not need to attend. Orientation* I will attend camp staff orientation (8:00 p.m.). Children's Worker Video* I have watched and understand the updated 2015+ edition of the Maranatha children's worker video. This video is available on the main camp page in the drop-down under "All Adults Involved with Camp" Children's Worker Policies* I have reviewed and understand the updated 2015+ edition of the Maranatha children's worker rules. This information is available on the main camp page in the drop-down under "All Adults Involved with Camp" Reference CheckAgreement to Abide by Policies* I agree to abide by the children's worker rules and leadership instructions in my service with children on the behalf of Maranatha. Reference Check Consent* I agree to a reference check. Reference 1 Name* First Last Phone*Email* Relationship to you*Reference 2 Name* First Last Phone*Email* Relationship to you*Background Check Release FormBackground Check Consent* I agree to a background check. PLEASE NOTE: You will receive an email to the address listed above within the next several days from Brenda Kurtz at Maranatha. This email will contain a link to a secure online form provided by ScreeningONE. The link will remain active for 14 days. We request that you complete the form at your earliest convenience. NOTIFICATION AND RELEASE Maranatha Baptist University & Seminary 745 West Main Street, Watertown, WI 50934 The information contained in this Notification and Release is for use in my role working and/or volunteering with minors at Maranatha Baptist University & Seminary (hereinafter, “Maranatha”) and is true to the best of my knowledge and belief. I understand that any misrepresentation or false statement made by me in connection with this Notification and Release or any related documents which is deemed material by Maranatha shall result in Maranatha declining use of my services or requesting my dismissal from Maranatha-sponsored camps and events. I understand and agree that all information furnished may be verified by Maranatha or its authorized representative. I hereby acknowledge that I have been informed by Maranatha that Maranatha may seek to obtain an investigative report that will include personal information regarding me, including but not limited to, educational history, work references, driving record, drug testing and criminal convictions or arrest records if allowed, in order to assist Maranatha in making certain decisions. I further acknowledge notification by Maranatha that reports may be provided to Maranatha by other firms subcontracted for that purpose. I, my heirs, assigns and legal representatives, hereby release and fully discharge Maranatha, its parent and affiliated companies and the respective officers, directors, shareholders, employees, agents of each, including subcontractors, from any and all claims, monetary or otherwise, that I may have against Maranatha, its parent, affiliates or subcontractors, arising out of the making, or use of, an investigative report, including any errors or omissions contained or omitted from such reports or investigations. Maranatha agrees to inform you if the decline of your services has been influenced by information contained in such reports.Signature By signing this form, I agree to fulfill the camp staff requirements if I qualify and am selected for this position.Online SignatureDate Date Format: MM slash DD slash YYYY This iframe contains the logic required to handle Ajax powered Gravity Forms.