DPB Summer New Volunteers Form

Volunteer Application Form:
Please use "N/A" in any required field that is not relevant to your situation.
Volunteer's Full Name *

First Name Middle Name Last Name
Age *
Birth Date *

Month Day Year

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

E-mail *
Home Phone Number *
Mobile Number
OIB or Passport Number *
Identificación
ID Type *

Passport
Gender *

Male Female
Nationality *
Dominant Language *
Other Languages *
Check T-shirt Size *

Men's XS Men's S Men's M Men's L Men's XL Men's 2XL Women's XS Women's S Women's M Women's L Women's XL
Please indicate the how you would like to be involved with DPB:

MK HS Camp Staff MK MS Camp Staff International Camp Staff English Camp Staff Summer Work Crew Camp Nurse Camp Photographer Camp Videographer
Educational Background
Check All that Apply

High School (What year completed?) High School Diploma College (Enrolled) College Degree Other
Name of High School or College *
Provide other Information regarding Education Background
Additional Training: List any Certifications you have completed
Emergency Contact Information
Emergency Contact (Middle not required and you may put N/A) *

First Name Middle Name Last Name
Mobile Number *
Personal E-mail *
Relationship *
Skills & Talents
Program

Check Level of Program Proficiency

Advanced

Intermediate

Beginner

None

Bible Study Leading

Camp Ministry

Children's Ministry

Drama

Group Game Leading

Public Speaking - Bible Teaching

Small Group Facilitation

Support Services for those with Development Needs

TEFL (Teaching English as a Foreign Language)

Teen Ministry

Other

Explain Program Experience
Community Relations

Check Level of Community Relations Proficiency

Advanced

Intermediate

Beginner

None

Art (Painting, Drawing, Other)

Fund Raising

Graphic Design

Photography

Social Media Ministry

Videography

Video Editing

Writing Blogs

Writing Newsletters

Writing Stories

Explain Community Relations Experience
Operations

Check Level of Proficiency

Advanced

Intermediate

Beginner

None

Carpentry

Dish Washing

Electric Work

Gardening

House Cleaning

Laundry

Lawn Mowing

Maintenance

Meal Preparation

Plumbing

Explain Everything Marked Advanced
Specialty Skills

Check Level of Proficiency

Coach/Instructor

Advanced

Intermediate

Beginner

None

Archery

Basketball

Backpacking

Canoeing

Caving

Crafts

Environmental Education

Flag-football

Orienteering

Playing Instrument

Rock Climbing

Soccer

Swimming

Volleyball

Wood working

Explain Experience for everything marked Advanced or Higher
Interests
List any interests you have. This could include areas like art, something you collect, reading, music, a favorite subject, what you do in your free time.
Interests
EDUCATIONAL SUPPORT INFORMATION
Have you been diagnosed with any behavioral, development or academic difficulties? *

Yes No
Have you been diagnosed with any behavioural, development or academic difficulties? Please indicate the diagnosis and tests carried out to obtain the diagnosis.
Do you have any concerns regarding your ability to learn? *

Yes No
Do you have any concerns regarding your ability to learn? If yes, please comment:

Have you ever received support from one of the following? *

Yes/No

Learning Support Teacher/Special Needs Teacher

Speech Pathologist

Occupational Therapist

Psychologist

Counselor or Therapist

Have you ever had an Individual Education Plan?

Have you ever had a Psycho-Educational Assessment?

Have you previously needed a full-time or part-time individual learning assistant?

Have you ever had a diagnosis of: *

Yes/No

Autism

Asperger’s Syndrome

Language Delay

Developmental Delay

ADHD/ADD

Learning Disability

If you answered yes to any of the above, please give details and attach any supporting documentation.
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Medical Information
Allergies
Are you allergic to any of the following?

Insects Foods Medicine (e.g., penicillin, aspirin, sulfa drugs) Environmental Other
If you checked any, describe allergic reaction and how you treat it.
Diet
Do you require a special diet? If yes, please explain.
Tetanus
Date of last tetanus shot:
History
Do you have a history of any of the following:

heart conditions seizures abnormal blood pressure stomach problems knee or joint problems hearing problems arthritis Raynaud's Sundrome frostbite hypothermia past surgery breathing conditions (including asthma) diabetes back problems vision problems (including glasses or contacts) corrective brace or device migraines dizzines poor circulation toothaches periods of unconsciousness Other
If yes to any of the conditions, have you been treated? Explain.
Have you taken or do you presently take any medications on a regular basis? If yes, describe.
Is there anything else that we should know about you (e.g., phobias, special needs, sensitivities)?
Is there any restriction on physical activity? *

Yes No
Is there any restriction on physical activity? Please Specify
Spiritual Life and Background Questions
Have you participated in any of the DPB House program? (Check All that Apply)

Camper CREW (Operations) Counselor Helper Camp Counselor Head Trainer (Formerly Head Camp Counselor) Program Director
Describe your salvation experience or journey of faith: *
How has God been working in your life over the past few weeks/months? *
Describe why you want to serve with DPB: *
What is your understanding of the Great Commission? *
What Church or Church-Plant do you currently actively attend? *

Church Address:

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

What is your present attitude and practice regarding tobacco, alcohol and drugs? *
If you are not married and dating, what are your personal boundaries for the physical aspect of your relationship?
What is your view of sex outside of marriage? *
Background checks are required by law in Croatia if you work with minors and you will need to provide us with one. If you are a summer worker or intern and have been accepted into one of those programs your background check will be on file.
Statement of Faith
The DPB Kuća is an interdenominational Christian camp ministry and as such we need to know

that all volunteers agree to the following statement of faith:

We believe in the Holy Scriptures as originally given by God divinely inspired, infallible, entirely

trustworthy, and the supreme authority in all matters of faith and conduct; the triune God: Father, Son, and Holy Spirit; the deity of the Lord Jesus Christ, His substitutionary atonement for sin, His bodily resurrection, His personal, visible return to earth to reign in righteousness and glory; the Person of the Holy Spirit and His work of conviction, regeneration, and sanctification, Who indwells every believer, equipping them with gifts for service and witness; the necessity of new birth, in salvation by faith in Jesus Christ alone, and the importance of a life fully committed to the will of God in Christ and the church as the one universal body of Christ Who is the Head, called to be God’s redeemed people.

If you can agree to the above type or sign below and give today’s date:
Full Name (Statement of Faith)

First Name Last Name
Date (Statement of Faith)

Month Day Year
at
Hour Minutes AM/PM Option Date Picker Icon
Reference Information
List three references who will be filling out your reference forms:

Reference 1: Pastor, youth worker, camp leader, Bible study leader

References 2*: Character References (Required for those going through SEND International, USA)

Please note references are not to be family members.
Reference 1: *

First Name Last Name
Reference 1 Position: *

Reference 1 Address: *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Reference 1 E-mail: *
Reference 1 Mobile/Cellphone: *
Reference 2: *

First Name Last Name
Reference 2: Position: *

Reference 2 Address: *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Reference 2 E-mail: *
Reference 2 Mobile/Cellphone: *
Reference 3: *

First Name Last Name
Reference 3: Position: *

Reference 3 Address: *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Reference 3 E-mail:
Reference 3 Mobile/Cellphone:
I hereby give permission to contact the above reference and any secondary reference my reference may suggest.
Reference Permission: *

First Name Last Name
Reference Permission Date: *

Month Day Year
at
Hour Minutes AM/PM Option Date Picker Icon
Financial Information
Cost will be determined based on the duration and needs of each volunteer. We will be communicating with you as to how much cost it would be.
Ways to Connect!
Ways to Connect!

Pray for DPB House Ministries Allow us to TAG you on DPB posts on Facebook (This increases the reach of the ministry) Contribute art, video, photos or blog entries for website and Facebook Receive the DPB House Newsletter
Disclosure Clause: By submitting this application, the intern, student or summer worker certify that, at the time of application/admission, all information pertinent to this application is accurate to the best of the applicant's knowledge. Failure to declare accurately and fully all pertinent information may result in the annulment of the application or DPB's acceptance offer or you may be required to withdraw from the program.

Volunteers coming through SEND International: By submission of this application give permission for your application, reference forms and background checks to be given to the members of the Short Term department from your sending country and the field leadership of the country where you plan to serve.
How did you hear about DPB *

Web Friend
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Volunteer Application Form:

Educational Background

Emergency Contact Information

Skills & Talents

EDUCATIONAL SUPPORT INFORMATION

Medical Information

Spiritual Life and Background Questions

Statement of Faith

Reference Information

Financial Information

Ways to Connect!