Summer Interest Form

1

Are you a:

New Applicant

Returning Applicant

2

What position are you interested in coming back?Choose one or more if applicable.

Cabin Counselor

Head Counselor

Servant Staff

Poiema Counselor

Water Front Coordinator

Camp Nurse / Nurses Aid

3

What position are you interested in coming back?Choose one or more if applicable.

Cabin Counselor

Water Front Coordinator

Camp Nurse / Nurses Aid

4

Full (Legal) Name* This field is required.

First Name

Last Name

5

Email* This field is required.

example@example.com

6

Phone Number* This field is required.

7

Gender* This field is required.

Female

Male

8

High School Graduation Year* This field is required.

(YYYY)

9

Preferred contact:You can select more than one.

Email

Call

Text