| Name | Diane Martin |
|---|---|
| Birthdate | 07/23/1962 |
| Gender | Female |
| T-shirt Size (adult sizes only) |
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| Main Area of Ministry | Cabin Councilor |
| Address | 5982 106th Terr N Pinellas Park, FL 33782 Map It |
| Phone | (727) 492-5073 |
| Alternate Phone | (727) 460-2848 |
| Email hidden; Javascript is required. | |
| Home Congregation | Pinellas Park church of Christ |
| Name of Elder or Minister for Staff Reference | Phillip Martin |
| Email of Elder or Minister for Staff Reference | Email hidden; Javascript is required. |
| Do you have any children that will be attending camp this year (Camper or Pre-Camper)? | No |
| Driver's Licence Information | |
| State | Florida Map It |
| Expiration Date | 07/23/2025 |
| Section Break | |
| Do you have any previous convictions or investigations that would prevent you from working with or being around children? | No |
| From time to time we must get background checks on all camp staff. Do you give the directors permission to perform a background check? |  I consent |
| Agreement | I have read the GUIDELINES FOR COUNCILORS posted above and agree to abide by them and verify that all the information provided in this application is true and accurate to the best of my knowledge. |
| Electronic Signature | |
| Today's Date | 05/26/2025 |
| HTML Block | We are grateful for your willingness to serve. Upon clicking SUBMIT your application will be processed and an email will be sent to the email provided for your staff reference. |
