2021 Summer Camp Staff Application
Street Address Line 2
Date of Birth
Date Picker Icon
Social Security Number
Drivers License Number
T Shirt Size
Desired Position (select all that apply)
Camp Director (limited to 1 opening)
Camp Counselor (must be at least 16 yrs of age)
Camp Driver (must be at least 25 yrs of age)
Camp Administrator (limited to 2 openings)
Our 2021 Summer Camp is a 3 week camp, July 12 - 30 (7:30 am - 3:30 pm with staff arriving at 7:15 am). Please select all weeks you are available to work.
Week 1: July 12 - 16
Week 2: July 19 - 23
Week 3: July 26 - 30
Select all grade groups with which you have experience working
Red Team (Kindergarten - 1st Grade)
Blue Team (2nd - 3rd Grades)
Green Team (4th - 5th Grades)
Yellow Team (6th - 7th Grades)
Education and Employment History
Provide Highest Level of Education (School, diploma/degree received, and dates attended)
Provide a list of past employers, dates worked, position held, and reason for leaving.
Expert Level Experience
Select your current certifications
What contributions do you believe you can make at the summer camp?
Explain how you would handle conflict between two campers.
Summer Camp requires flexibility, creativity, and the ability to work well with others. Describe a time when you worked well with others to help solve a problem and meet a goal.
Camp and/or Teaching Experience
Please answer the following if you have experience working at a school or camp.
Provide the following: 1. Name of Camp/School 2. Dates worked 3. Position held
Only list references, not related to you, who can attest to your work ethic and character
Provide 3 references (name, relationship to you, and phone number)
EMERGENCY CONTACT INFO
In the event of an emergency, please provide a contact person.
Emergency Contact Name
Relationship to Applicant
Emergency Contact Phone Number
Background Check Authorization
I authorize investigation of all statements herein, including any checks of criminal records, and release the camp and all others from liability in connection with same. I understand that misrepresentations or falsifications herein or submitted by me, the applicant, will result in dismissal upon discovery.
Printed Name of Applicant
Signature of Applicant
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