Summer Interest Form

1

Are you a:* This field is required.

New Applicant

Returning Applicant

2

What position(s) are you interested in?* This field is required.Choose one or more if applicable.

Cabin Counselor

Poiema Counselor

Day Camp Counselor

Head Counselor (for Overnight Camps)

Head Counselor (for Poiema Camps)

Head Counselor (for Day Camps)

Lifeguard

Media Assistant

Maintenance Assistant

Nurse Assistant

Water Front Coordinator

Activity Coordinator

Poiema Program Coordinator

3

Have you already filled out the nurse application?If not, please fill it out here.

YESNO

4

Are you interested in serving in any special ways such as:Choose one or more if applicable.

Leadership Roles

Worship Team

Lifeguard

Media Support (tech, photography, etc.)

Activity Leader

5

Full (Legal) Name* This field is required.

First Name

Last Name

6

Email* This field is required.

example@example.com

7

Phone Number* This field is required.

8

Gender* This field is required.

Female

Male

9

How old will you be by May 25, 2025?* This field is required.

10

High School Graduation Year* This field is required.

(YYYY)