Returning Staff Application


Learn more about the available positions for 2018 by clicking here

Personal Information

Which position are you applying for?:
What would be your second choice for a position?:
What would be your third choice for a position?:
First Name:
Last Name:
Current Address:
Postal Code:
Phone Number:
Alternate Number:
Social Insurance Number:

Emergency Contact Information

Contact Name:
Relationship to self:
Phone Number:
Alt Number:

Medical Information

Health Care Number:
Providing Province:

Medically Diagnosed Allergies

Foods (specify):
Drugs (specify):
Other (i.e. Bee Stings):
My camper carries an Epipen: No Yes  for the following allergy:

Food Restrictions/Intolerances (if applicable)

Note: All dietary constrictions must be listed here prior to the start of the session. All special dietary needs will be shared with the kitchen staff. Please note Mill Creek Camp menus DO NOT cater to likes/dislikes. We have a balanced and varied menu that does include red meat, poultry and fish.
Select all that apply:  Vegetarian (no meat) Vegan (no meat/byproducts) Celiac Disease Lactose Intolerant


Is your camper bringing medications to camp? No Yes 
Please list ALL medications being sent to camp. Medications MUST be in original packaging. (Medication Name/Dosage/Administration Time/Reason for Taking)

Please answer the following questions:

Tetanus Immunization Date -must be current (Mandatory):
Are there any immunizations that you have chosen NOT to give your camper?:
Please indicate any significant medical conditions, physical limitations, or other concerns which will help us effectively care for your camper:  Anaphylactic Allergy Asthma Bed Wetting Concussions/Head Injuries Diabetes Ear/Nose/Throat Infection Epilepsy Migraine Headaches Recent Illness/Injury Mental Health Concerns
If any of the above were selected, please explain:
To the best of my knowledge, the information on this medical record is complete, current, and accurate: No Yes 

To the best of my knowledge, I do not have a communicable disease, and am physically able to participate in all Camp activities except as
indicated above. No Yes 

All medical problems or conditions requiring ongoing medical supervision or care have been fully noted. I give permission for this health information to be shared with the appropriate Camp staff and outside Medical Personnel as necessary. I understand that I will be notified if extended care has been provided by the Camp Health Staff, or following assessment or treatment by a local physician.In the case of an emergency, if I cannot be reached, permission is hereby given to the Camp staff to take whatever steps deemed necessary to ensure the safety and health of myself. This also allows permission for the Camp to contact my family physician/specialist. (Please inform your physician/specialist that you have given this authorization.)No Yes 

I agree to notify the Camp in writing if any changes occur in my health status, medications, or family
status between now and the start of the Camp session.  No Yes

Other Information

T-Shirt Size:
Drivers License?
Have you ever been convicted of a criminal offence or are there current charges before the court?
If yes, please explain:
Do you have current training in First-Aid and CPR?
Do you have any physical limitations or disabilities which may affect working at camp?
If yes, please explain:

Tell Us About Yourself

Why do you want to return to the staff team at Mill Creek Camp?

Why are you the best fit for this position?
Which position are you least suited for? Why?
Reflecting on your most recent work experience at Mill Creek Camp, was it a positive or negative experience? Why?

Describe your interaction with your faith over the past year:
How has camp positively impacted your life?
What would be the best "theme" in your opinion?
What woudl be the worst "theme" in your opinion?

Live the Adventure