Pastor’s Name(required) Title Counselor’s name(required) Camp Session(s) Counseling (i.e. Younger Midler, High School 1…) (required) Church Name & Address(required) Pastor’s Email(required) Pastor’s Phone Number(required) How often does this individual participate in worship?(required) Select one option Once a month Twice a month Three times a month Four times a month Does this person participate in other ministries or activities?(required) Select one option Yes No If yes, please list: How long have you known this person?(required) Are you comfortable knowing this person will facilitate spiritual growth of students in the camp/event?(required) Select one option Yes No If not, why? Is this person in any leadership positions at your church?(required) Select one option Yes No Has this person been disciplined by any ministries of the church?(required) Select one option Yes No If yes, please explain: Are you aware of any accusations of misconduct involving this person?(required) Select one option Yes No Are there any character issues that would hinder this person from being an important part of the counselor team?(required) Additional Comments? By checking this box, I certify that this form is filled out as accurately and truthfully as possible.(required) Send
