First Name:
Last Name:
Mailing Address:
Permanent Address:(if different from mailing address)
City:
State and/or Country:
Zip or Postal Code:
Home Phone #:
Work Phone #:
Email Address:
Date Of Birth:
Height:
Weight:
Gender:
Male Female
Do You Have A Driver's License? Yes No
Would You Bring A Car To Camp? Yes No
Drivers License Number:
Issuing State:
Are You A Smoker? Yes No
Education (Please include schools attended, major subjects, years, and degree(s) you earned):
Camp or related experience (Please include position held, camp information, director information, and dates, experience with children, leadership or volunteer positions):
Please include 2 references:
**In the following list, put a "1" next to the activities you can teach and organize; put a "2" next to those activities you can assist in teaching.
Photography:
Batik:
Bead Work:
Candle Making:
Clothes Making:
Embroidery:
Enameling:
Kite Making:
Jewelry (Silver):
Leather Work:
Macrame:
Papier Mache:
Painting:
Pottery (Wheel):
Printing:
Sculpture:
Sewing on Machine:
Silk Screen:
Sketching:
Stained Glass:
Tie-Dye:
Video:
Weaving:
Woodworking:
Aerobics:
African Dance:
Ballet:
Folk:
Interpretive:
Jazz:
Modern:
Tap:
Yoga:
Basketball:
Initiative Games:
Fencing:
Lacrosse:
Floor Gymnastics:
Floor Hockey:
Frisbee:
Jogging:
New Games:
Soccer:
Softball:
Tennis:
Touch Football:
Volleyball:
Weight Lifting:
Martial Arts:
Clowning:
Experimental:
Improvisational:
Juggling:
Mime:
Play Directing:
Skits and Stunts:
Theater Games:
Stage Combat:
Mountain Biking:
Bocce Ball:
Carpentry:
Creative Writing:
Computers:
Evening Programs:
Sign Language:
Truck / Bus Driver:
Low Ropes:
High Ropes:
Culinary Arts:
Riding:
Horse/Animal Care:
Ecology:
Gardening:
Hiking:
Overnight Camping:
Guitar:
Piano:
Recording Studio:
Singing:
Instrumental:
Canoeing:
Drive Speed Boat:
Life Saving:
Sailing:
Swimming:
Windsurfing:
Water Skiing:
Do you hold a current WSI or Lifesaving Certifate? Yes No Indicate and Give Dates:
Do you hold a current First Aid or CPR Certificate? Yes No Indicate and Give Dates:
Please list your best 3 activities and your background in those areas:
Personal Statement or Personal Information:
What do you suppose will be your greatest difficulty at camp:
Do you have any medical conditions, physical disabilities, or allergies? Yes No If yes, Please explain:
Have you ever been convicted of a crime against or involving children? Yes No
By submitting this application, the applicant hereby guarantees that all information given via this application are true and were submitted by the applicant. If hired, the applicant may be subject to a background check and if a background check is performed or during employment it is revealed that the applicant supplied false information, employment may be terminated at once.
