Application for Assistant Camp Leader 2023

Application for Assistant Camp Leader

CAMP OVERBROOK: IN SIGN 2023 / JUNE 20-29, 2023 (Weekdays Only) St. Joseph's University City Campus, 600 S. 43rd Street, Philadelphia, PA 19104
PLEASE COMPLETE THE INFORMATION REQUESTED BELOW.
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Email
Phone

Area CodePhone Number
VoiceVideo Phone
Cell /Text Phone

Area CodePhone Number
Birth Date

MonthDayYear
Sex

MaleFemale
Church / City
High School
Year Graduated
College
Year Graduated
Emergency Contact

First NameLast Name
Phone Number

Area CodePhone Number
Please indicate your T-shirt size;
Please check Youth Organizations if you belong:

CYOCSCScoutsStudent CouncilChurch Youth Group
Did you have a leadership role in any of these groups? If yes, where and what year.
Have you attended any leadership programs? If yes, where and what year?
What Deaf Apostolate Activities have you attended? (Mass, Workshops, Religion Classes, Retreats)
Have you attended a summer camp as a kid?

YesNo
If yes, where?
Are you working?

YesNo
Where?
For how long?
What are/were your responsibilities?
Have you ever worked with children ages 6-15?

YesNo
If yes, describe your duties with children?
Check the language skills that you are fluent in.

ASL - American Sign LanguageEnglish Sign LanguageVoice EnglishSpeak Spanish
Please indicate if you have certification in any of these areas:

Life GuardFirst AidCPRAID
Criminal Record Check completed?

YesNo
American Sign Language is the primary language used at

CAMP OVERBROOK IN SIGN.
Adults (over 18 years of Age) who work with children are required by law to have a PA State Child Abuse History Clearance, Criminal Record Check and Arrest/Conviction Report & Certification Form (under Act 24 of 2011). Please submit the originals of these documents with your application. W-9 forms are required for all paid staff.
Child Abuse Clearance completed?

YesNo
I need to submit these forms to be processed.

YesNo
I have attended the Archdiocesan Safe Environment Workshop.

YesNo
Why do you want to be an Assistant Camp Leader at CAMP OVERBROOK: IN SIGN 2023?
CAMP OVERBROOK: IN SIGN requires two references. Below, write the names and addresses of (1) a teacher, boss or supervisor from work (2) an adult who knows you but is not related to you. The Camp Director will contact these people as soon as your application is submitted. (If you worked at camp last year you do not need to give references).
REFERENCE (1)

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone

Area CodePhone Number
VoiceVideo Phone
Cell/Text Phone

Area CodePhone Number
Email
REFERENCE (2)

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone

Area CodePhone Number
VoiceVideo Phone
Cell/Text Phone

Area CodePhone Number
Email
Should be Empty: