Application for Camp Leader 2023

Application for 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
Emergency Contact

First NameLast Name
Phone

Area CodePhone Number
Cell/Text Phone

Area CodePhone Number
Please indicate your T-shirt size:
What is your educational background?
Please describe your work experiences.
Have you ever worked with deaf/hard of hearing children ages 6 through 15?

YesNo
If yes, where have you worked with deaf/hard of hearing children 6-15 years old?
Have you had experience teaching the Catholic Religion?

YesNo
If yes, where and what class have you taught?
Are you involved with Catholic Deaf Apostolate activities? If yes, list them.
Check the language skills in which you are fluent.

ASL American SignLanguageEnglish Sign LanguageSpeak EnglishSpeak Spanish
Do you have current certification in any of these areas?

Life GuardFirst AidCPRAID
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.
Criminal Record Check completed?

YesNo
Child Abuse Clearance completed?

YesNo
I have attended an Archdiocesan Safe Environment Workshop.

YesNo
Why do you want to be a Camp Leader at CAMP OVERBROOK: IN SIGN?
Rate Yourself

Please rate your abilities below from 1 to 5 (5 being the highest and 1 the lowest)

	Rate Abilities (from 1 to 5)
Discipline
Teaching
Swimming
Sports
Arts & Crafts
Drama
Be on time
Responsibility
Interact with Children
Open Communication
Motivation
Organized
Commitment
Show up every day

CAMP OVERBROOK: IN SIGN requires two references. Write the names and addresses of (1) a teacher, boss or supervisor from work (2) another adult who knows you well but is not related to you. The Camp Director will contact these people as soon as your application is submitted. (Those who have worked at camp the last two years do not need to list references.)
REFERENCE (1)

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone

Area CodePhone Number
Phone Type

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
Phone Type

VoiceVideo Phone
Cell/Text Phone

Area CodePhone Number
Email
Should be Empty: