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General Information

Full Name (First, Middle, and Last) *

Birthday*

Month

Day

Year

Age*

Gender*

Male

Female

Address (Street, City, State, ZIP)*

Phone

Email

Emergency Contact

Emergency Contact Name*

Emergency Contact Phone Number*

Relationship*

Position Information

Position Applying For:*

Counselor

Junior Counselor

Support Staff (Kitchen, Cleanup)

Medical Staff

Nurse

Weeks Available to Serve:*

Weekend 1 (June 12-14)

Weekend 2 (June 19-21)

Weekend 3 (June 26-28)

Have you worked at a camp before?*

Yes

No

Describe your experience working with children/youth.

Check any relevant skills.

Teaching/Leading Devotions

First Aid/CPR Certified

Sports/Games Leadership

Music/Worship Leading

Conflict Resolution

Background

Are you a Christian?*

Yes

No

How long have you been a Christian?

What church do you currently attend? (Name, City/State, How often?)

Are you involved with your church? If so, how?

Describe you personal testimony (If applicable).

Are you willing to uphold Christian values and serve as a role model for campers?*

Yes

No

Are you willing to follow all camp rules, leadership, and expectations?*

Yes

No

Healthy and Safety

Do you have any medical conditions we should be aware of?

Do you have any allergies?

Are you currently taking any medications?

Do you have any physical limitations?

Pastoral Reference

Pastor's Name

Church

Position (Pastor, Youth Pastor, etc.)

Phone Number

Email Address

How long have you known this person?

Personal Reference

Name

Relationship

Phone Number

Email Address

How long have you known this person?

Commitment Statement

I understand that serving at this Epic Ministries Youth Camp is both a responsibility and a ministry opportunity. I commit to serving with integrity, representing Christ in my actions, and supporting the mission of the camp.

Signature (Typed)*

Signature*

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ABOUT EPIC

What began as a small youth group led by three young adult friends has grown into something bigger. As E.P.I.C. heads into 2026, we are excited to launch our free Christian summer camp—an outreach designed to serve and support families across the Erie and Warren communities. Through faith, fun, and fellowship, we look forward to welcoming many more children and families in the years ahead.

CONTACT

Phone: 814-529-1071

Email: jsipe2017@gmail.com

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