Returning Counselor Application The application will open on Wednesday March 1, 2017. Applicant Information Full Name Phone Number Email Address Home Address Birthdate Shirt Size Are you able to be in Mesa, AZ by June 10 for Counselor Training? ---YesNo Are you able to be in Mesa, AZ for the full week of June 12-16? ---YesNo Ecclesiastical Information Ward/Stake Bishop's Name Are you comfortable with us contacting your Bishop? ---YesNo Hobbies & Skills What hobbies and skills would you be willing to teach or share? (Examples: Exercise Class, Games, Lead Music, Lifeguard, Line Dancing, Musical Instrument, Singing, etc.) Medical Information Describe any medical, physical, or emotional concerns or limitations that may affect you during the conference. If none, please enter “None”. Explain what we would need to do in case of an emergency (include symptoms and signs to be aware of). If none, please enter “None”. Do you have any experience dealing with conditions like diabetes or food allergies? Policies Emergency Medical Treatment Policy Counselors will be given any/all emergency medical treatment deemed necessary by a licensed practitioner if they are unable to make a decision or parents are unavailable. This authorization does not cover major surgery unless the medical opinions of one other physician or dentist, concurring in the necessity for such surgery, are obtained prior to the performance of surgery. Counselors or parents will be responsible for any expenses incurred for such treatment. Time to Blossom insurance does not cover illness (such as cold symptoms, stomach aches, etc.) or pre-existing conditions. This consent is valid during conference hours only. ---YesNo Safety Policy Time to Blossom reserves the right to ensure the safety and well-being of all attendees and will dismiss anyone for misconduct as determined by the directors. Fighting, stealing, damaging property, possession or use of any harmful weapons, drugs, or alcohol, leaving the conference center or hotel/hotel room without permission, or after curfew are grounds for being sent home early. Counselors who leave the conference center or hotel without permission will not be included in the limited coverage ($100,000 maximum benefit) accident insurance policy. Counselors who are sent home early will be responsible for their own transportation and will not be paid. ---YesNo Dress Code Policy Counselors are expected to wear clothing that meets the standards of The Church of Jesus Christ of Latter-day Saints found in the For the Strength of Youth pamphlet. Clothing should be modest, neat, and clean in appearance and fit. Shorts, skirts, and dresses must extend to at least the knee (even when wearing leggings). Shorts, pants, and jeans must not have any holes. Shirts must cover the chest, stomach, back, and shoulders. Sheer or lace tops must be worn over a shirt with sleeves that cover the shoulders (no tank tops or camisoles). ---YesNo Photo Release Policy Counselors and activities are photographed and videotaped during the conference. Photographs and videos will be used for newspaper articles, brochures, advertisements, social media, and other promotional materials. ---YesNo Upload a current photo of yourself.