Counselor Registration

ALL Counselor applicants need prior approval from the Session Director.
Counselor Information

Please complete ALL questions.
Counselor's Name*

First NameLast Name
MaleFemale
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
Email*
example@example.com
I am applying to serve as a:

Select counselor position and session number.
Select Counselor position*
Select .
Select Session*
Select Session Attending.
YES
Background Check

ALL counselor's, Cooks, and Session Staff are required to complete a back ground check in order to participate in a camping session.
Full Legal Name*

First NameMiddle NameLast Name
Birth Date: *

MonthDayYear
Date
Driver's License Number *
Please enter your number and State
Camp T-Shirt

A t-shirt is included in the registration fee. Please select the desired size for your camper.
Camper T-Shirt Size*
Emergency/Alternate Contact Information
Emergency Contact's Name*

First NameLast Name
Relationship*
Phone Number*

Area CodePhone Number
Photo/Video Release

If given permission, we may use your camper's image for publicity purposes.
YesNo